Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 32496 | AZ |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 32496 | AZ |
NPI | 1720050156 |
---|---|
Provider Name | Stephen Knecht |
First Address | Flagstaff, AZ 86001 |
Second Address | Flagstaff, AZ 86001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 02/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
855322 | (05) | AZ |
I02723 | (02) | AZ |