Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 207006526 | MO |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | A-1437-08 | NM |
Y | 2081S0010X | Sports Medicine | A1437-08 | NM |
Y | 213ES0000X | Sports Medicine | A1437-08 | NM |
NPI | 1164567848 |
---|---|
Provider Name | Evan R Knaus |
First Address | Albuquerque, NM 87106 |
Second Address | Albuquerque, NM 87106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 01/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
204454102 | (05) | MO |
89077083 | (05) | NM |
I74167 | (02) |