Provider Demographics
NPI:1356382022
Name:MCKNIGHT, BRIAN BRENDAN (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:BRENDAN
Last Name:MCKNIGHT
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 1:1900 NEBRASKA AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4837
Mailing Address - Country:US
Mailing Address - Phone:772-460-8600
Mailing Address - Fax:772-460-8866
Practice Address - Street 1:1900 NEBRASKA AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4837
Practice Address - Country:US
Practice Address - Phone:772-460-8600
Practice Address - Fax:772-460-8866
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0066522174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF04001Medicare UPIN
FL110103831Medicare ID - Type Unspecified