Doctor Name: | EDWARD J KNOLL |
NPI Number: | 1033118054 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | MD00015770 |
Business Practice Address: | 800 Meridian S Suite B Puyallup, WA - 983716995 |
Business Phone Number: | 2538459511 |
Business Fax Number: | 2538403513 |
Mailing Address: | 800 Meridian S, Suite B PUYALLUP |
State: | WA |
Postal Code: | 983716995 |
Phone Number: | 2538459511 |
Fax Number: | 2538403513 |
NPI Enumeration Date: | 07/20/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 204C00000X |
License Number: | MD00015770 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Neuromusculoskeletal Medicine, Sports Medicine |
Taxonomy Specialization: | |
Taxonomy Definition: |