Provider Demographics
NPI:1871541805
Name:KNOX, PHILIP JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JAMES
Last Name:KNOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4107
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-4107
Mailing Address - Country:US
Mailing Address - Phone:208-232-7760
Mailing Address - Fax:208-232-1950
Practice Address - Street 1:333 N 18TH AVE
Practice Address - Street 2:BLDG A
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3358
Practice Address - Country:US
Practice Address - Phone:208-232-7760
Practice Address - Fax:208-232-1950
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-3651207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003783100Medicaid
ID1116915Medicare ID - Type Unspecified
ID003783100Medicaid