Provider Demographics
NPI:1871528448
Name:KNATT, THEODORE SR (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:
Last Name:KNATT
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TEDDY
Other - Middle Name:
Other - Last Name:KNATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-5727
Mailing Address - Fax:225-765-4278
Practice Address - Street 1:4630 AMBASSADOR CAFFERY PKWY STE 206
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6949
Practice Address - Country:US
Practice Address - Phone:337-470-3887
Practice Address - Fax:337-470-3896
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.021167207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1907600Medicaid
MS00119259Medicaid
LAE64567Medicare UPIN
LA276455YH3VMedicare PIN
LA1907600Medicaid