Provider Demographics
NPI:1417796525
Name:KNAB, RICHARD ALEXANDER (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALEXANDER
Last Name:KNAB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3946 SAINT JOHNS AVE APT 703
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-9496
Mailing Address - Country:US
Mailing Address - Phone:703-475-5792
Mailing Address - Fax:
Practice Address - Street 1:2080 CHILD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32214-5005
Practice Address - Country:US
Practice Address - Phone:904-542-7300
Practice Address - Fax:904-542-7394
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program