Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 219949 | MA |
N | 208600000X | Surgeon | 219949 | MA |
N | 208200000X | Surgeon | 49459 | CO |
N | 208600000X | Surgeon | 49459 | CO |
Y | 208200000X | Surgeon | 8793 | SD |
Y | 208600000X | Surgeon | 8793 | SD |
N | 2086S0102X | Surgical Critical Care | 04-29219 | KS |
NPI | 1255317038 |
---|---|
Provider Name | Dr. Jason Knudtson |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Sioux Falls, SD 57105-1508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 15/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2043840 | (05) | MA |
53636 | (02) | MA |