Provider Demographics
NPI:1073500294
Name:KNOPKE, CARL GEORGE III (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:GEORGE
Last Name:KNOPKE
Suffix:III
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 1:4646 BROCKTON AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-0102
Mailing Address - Country:US
Mailing Address - Phone:951-774-2723
Mailing Address - Fax:951-231-1361
Practice Address - Street 1:4646 BROCKTON AVE
Practice Address - Street 2:STE 302
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-0102
Practice Address - Country:US
Practice Address - Phone:951-774-2723
Practice Address - Fax:951-231-1361
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I11058Medicare ID - Type Unspecified