Basic Information
| Provider Information | |||||||||
| NPI: | 1457436602 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KNAPP | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99371 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761990371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828851855 | ||||||||
| FaxNumber: | 6828857347 | ||||||||
| Practice Location | |||||||||
| Address1: | 480 W SOUTHLAKE BLVD | ||||||||
| Address2: | STE 133 | ||||||||
| City: | SOUTHLAKE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760926162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173299234 | ||||||||
| FaxNumber: | 8173299239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 04/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | E1001 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 87350S | 01 | TX | BCBSTX IND PIN | OTHER | KNARC17962 | 01 | TX | CCHIP PIN | OTHER | 152424 | 01 | TX | PHCS PIN | OTHER | 4369262 | 01 | TX | AETNA PIN | OTHER | 737821 | 01 | TX | FIRSTHEALTH PIN | OTHER | 00U87Z | 01 | TX | BCBSTX GRP PIN | OTHER | 1750369203 | 01 | GRP NPI NUMBER | OTHER | 117218102 | 05 | TX | MEDICAID | 140442831 | 05 | TX | MEDICAID | 47652 | 01 | TX | UHC PIN | OTHER | 140442870 | 05 | TX | MEDICAID | 2961700 | 01 | TX | CIGNA PIN | OTHER |