Basic Information
| Provider Information | |||||||||
| NPI: | 1033267794 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KNIGHT | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6565 FANNIN | ||||||||
| Address2: | M1-072 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134413488 | ||||||||
| FaxNumber: | 7137903781 | ||||||||
| Practice Location | |||||||||
| Address1: | 6550 FANNIN ST | ||||||||
| Address2: | SMITH 1101 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134410006 | ||||||||
| FaxNumber: | 7137902727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 08/28/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | C52449 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | N4526 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 210045502 | 05 | TX | MEDICAID | 210045501 | 05 | TX | MEDICAID | 1033267794 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | P01055780 | 01 | TX | RR MEDICARE | OTHER |