Basic Information
| Provider Information | |||||||||
| NPI: | 1386891620 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KNIGGE | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 MAR WALT DR | ||||||||
| Address2: | |||||||||
| City: | FORT WALTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325476708 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 MAR WALT DR | ||||||||
| Address2: | |||||||||
| City: | FORT WALTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325476708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508621111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2008 | ||||||||
| LastUpdateDate: | 11/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | OP60652158 | WA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | DO.1099 | AL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | O-0997 | ID | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 34.011427 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | OS15734 | FL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.