Provider Demographics
NPI:1104896158
Name:KNAUER, W J III (MD)
Entity type:Individual
Prefix:DR
First Name:W
Middle Name:J
Last Name:KNAUER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:W
Other - Middle Name:J
Other - Last Name:KNAUER
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2535 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4710
Mailing Address - Country:US
Mailing Address - Phone:904-388-6548
Mailing Address - Fax:904-389-8157
Practice Address - Street 1:2535 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4710
Practice Address - Country:US
Practice Address - Phone:904-388-6548
Practice Address - Fax:904-389-8157
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41501207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069417700Medicaid
FL15821Medicare ID - Type Unspecified
FL069417700Medicaid