Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | G43057 | CA |
N | 2084N0400X | Neurologist | G43057 | CA |
N | 2084N0402X | Child Neurologist | G43057 | CA |
N | 2084N0600X | Clinical Neurophysiologist | G43057 | CA |
NPI | 1407032824 |
---|---|
Provider Name | Dr. Richard P. Knudsen |
First Address | Novato, CA 94945 |
Second Address | Novato, CA 94945 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2008 |
Last Update Date | 21/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11644674248 | NPI (01) | CA |
262657160 | TAX ID (01) | CA |
A09138 | (02) |