Provider Demographics
NPI:1548252166
Name:KNECHT, JOHN G II (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:KNECHT
Suffix:II
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 39TH ST
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-6605
Mailing Address - Country:US
Mailing Address - Phone:409-762-6433
Mailing Address - Fax:409-762-8245
Practice Address - Street 1:1529 39TH ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-6605
Practice Address - Country:US
Practice Address - Phone:409-762-6433
Practice Address - Fax:409-762-8245
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0451213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121585701Medicaid
TX121585701Medicaid
TX00R180Medicare ID - Type Unspecified