Provider Demographics
NPI:1104612183
Name:RED KNIGHT CLINIC LLC
Entity type:Organization
Organization Name:RED KNIGHT CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:WILBERT
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-466-8842
Mailing Address - Street 1:345 MOKO PL
Mailing Address - Street 2:
Mailing Address - City:LA CONNER
Mailing Address - State:WA
Mailing Address - Zip Code:98257-9535
Mailing Address - Country:US
Mailing Address - Phone:360-466-8842
Mailing Address - Fax:
Practice Address - Street 1:345 MOKO PL
Practice Address - Street 2:
Practice Address - City:LA CONNER
Practice Address - State:WA
Practice Address - Zip Code:98257-9535
Practice Address - Country:US
Practice Address - Phone:360-466-8842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty