Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 036133088 | IL |
N | 207RA0201X | Internist - Allergy & Immunology | 44933 | WI |
N | 208D00000X | General Practice Physician | 44933 | WI |
NPI | 1184690109 |
---|---|
Provider Name | Jason E Knuffman |
First Address | Quincy, IL 62301-4038 |
Second Address | Quincy, IL 62301-4038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 08/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
059D15875 | (02) | WI |
34583000 | (05) | WI |
I19614 | (02) |