Provider Demographics
NPI:1073559944
Name:KNUTSON, SARA W (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:W
Last Name:KNUTSON
Suffix:
Gender:F
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:PO BOX 10100
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-0008
Mailing Address - Country:US
Mailing Address - Phone:970-874-2470
Mailing Address - Fax:
Practice Address - Street 1:1450 BURGESS ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-2849
Practice Address - Country:US
Practice Address - Phone:970-874-7668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42988207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
COKN672320OtherBCBS
CO19774711Medicaid
CO840428757011OtherROCKY MOUNTAIN HEALTH PLA
COI25117Medicare UPIN
CO19774711Medicaid
COP00225630Medicare PIN