Provider Demographics
NPI:1053313452
Name:KNOWLES, PATRICK M (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:M
Last Name:KNOWLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W UTOPIA RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:602-214-6148
Mailing Address - Fax:602-214-6149
Practice Address - Street 1:5040 N 15TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3328
Practice Address - Country:US
Practice Address - Phone:602-248-0123
Practice Address - Fax:602-248-8506
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42670207Q00000X
AZ31722207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN377195400Medicaid
H23710Medicare UPIN
MN377195400Medicaid