Basic Information
Provider Information | |||||||||
NPI: | 1184838492 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SALLY M. KNOX, MDPA | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3535 WORTH ST | ||||||||
Address2: | STE. 610 | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 752462006 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2148269797 | ||||||||
FaxNumber: | 2148282089 | ||||||||
Practice Location | |||||||||
Address1: | 3535 WORTH ST | ||||||||
Address2: | STE. 610 | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 752462006 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2148269797 | ||||||||
FaxNumber: | 2148282089 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/09/2007 | ||||||||
LastUpdateDate: | 09/20/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | KNOX | ||||||||
AuthorizedOfficialFirstName: | SALLY | ||||||||
AuthorizedOfficialMiddleName: | M | ||||||||
AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
AuthorizedOfficialTelephone: | 2148269797 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086X0206X | F6973 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
ID Information
ID | Type | State | Issuer | Description | 080496501 | 05 | TX |   | MEDICAID |