Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 0758 | AZ |
N | 213ES0103X | Foot & Ankle Surgery | 2058 | TX |
NPI | 1063768877 |
---|---|
Provider Name | Dr. John David Knochel |
First Address | Peoria, AZ 85381-4412 |
Second Address | Peoria, AZ 85381-4412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2012 |
Last Update Date | 26/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
835018 | (05) | AZ |