Provider Demographics
NPI:1861472979
Name:KNIGHT, MELVIN JAY (MD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:JAY
Last Name:KNIGHT
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 1:5295 SUN VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89433-7954
Mailing Address - Country:US
Mailing Address - Phone:775-674-5430
Mailing Address - Fax:775-674-5440
Practice Address - Street 1:5295 SUN VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:NV
Practice Address - Zip Code:89433-7954
Practice Address - Country:US
Practice Address - Phone:775-674-5430
Practice Address - Fax:775-674-5440
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1427283860OtherCLINIC TAX NPI
NV2016810Medicaid
NVCC171ZOtherMEDICARE PTAN
NV94-1196203OtherCLINIC TAX ID
NVCC163AOtherCLINIC PTAN
NVCC171ZOtherMEDICARE PTAN