Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 28590 | CA |
Y | 213EG0000X | General Practice | 28590 | CA |
NPI | 1003824129 |
---|---|
Provider Name | John Knapp |
First Address | Redwood Valley, CA 95470-9629 |
Second Address | Redwood Valley, CA 95470-9629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/07/2007 |