Provider Demographics
NPI:1174557276
Name:KNIGHT, GLENN O (PAC)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:O
Last Name:KNIGHT
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Gender:M
Credentials:PAC
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Mailing Address - Street 1:805 MADISON ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1172
Mailing Address - Country:US
Mailing Address - Phone:206-264-8100
Mailing Address - Fax:206-264-8689
Practice Address - Street 1:7315 212TH ST SW
Practice Address - Street 2:SUITE 201
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7610
Practice Address - Country:US
Practice Address - Phone:425-778-8116
Practice Address - Fax:425-775-9526
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-10-07
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Provider Licenses
StateLicense IDTaxonomies
WAPA10003229363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB24592Medicare PIN
WAS54564Medicare UPIN