Provider Demographics
NPI:1306874631
Name:KNIGHT, PETER O (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:O
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DAVIS BLVD
Mailing Address - Street 2:STE 507
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3463
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 DAVIS BLVD
Practice Address - Street 2:STE 507
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3463
Practice Address - Country:US
Practice Address - Phone:813-254-2441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME08704207R00000X
FLME8704207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069921700Medicaid
FL29476OtherBLUE CROSS BLUE SHIELD
FL29476TMedicare PIN
FL29476ZMedicare PIN
FL069921700Medicaid
FL060021939Medicare PIN