Provider Demographics
NPI:1144257601
Name:KNOWLTON, ROBERT C (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:KNOWLTON
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:PO BOX 201088
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-1088
Mailing Address - Country:US
Mailing Address - Phone:713-512-2239
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST STE 1014
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-5301
Practice Address - Country:US
Practice Address - Phone:713-512-2239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL228172084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000045392OtherBLUE CROSS
AL000045392Medicaid
AL051513177OtherBLUE CROSS
LA1953547OtherEMERGENCY LA MEDICAID
MS00125120OtherMISSISSIPPI MEDICAID
AL130021547OtherRAILROAD MEDICARE
ALF64571OtherVIVA
AL130021547OtherRAILROAD MEDICARE