Provider Demographics
NPI:1841724507
Name:KNOTT, JEREMY S (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:S
Last Name:KNOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 ACORN DR
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:LA
Mailing Address - Zip Code:70584-6134
Mailing Address - Country:US
Mailing Address - Phone:337-470-7840
Mailing Address - Fax:337-470-7849
Practice Address - Street 1:127 ACORN DR STE B
Practice Address - Street 2:
Practice Address - City:SUNSET
Practice Address - State:LA
Practice Address - Zip Code:70584-6134
Practice Address - Country:US
Practice Address - Phone:337-470-7840
Practice Address - Fax:337-470-7849
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA324650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program