Provider Demographics
NPI:1063495067
Name:KNEPPER, JOHN ALLEN (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALLEN
Last Name:KNEPPER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:874 WHIPPLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8900
Mailing Address - Country:US
Mailing Address - Phone:843-884-2133
Mailing Address - Fax:843-849-9466
Practice Address - Street 1:570 LONG POINT RD STE 130
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7931
Practice Address - Country:US
Practice Address - Phone:843-884-2133
Practice Address - Fax:843-884-2868
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC0379207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC003793Medicaid
SC6645Medicare ID - Type Unspecified
SCF92869Medicare UPIN