Provider Demographics
NPI:1073705273
Name:KNOBLER, STACEY BLAIR (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:BLAIR
Last Name:KNOBLER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:6548 S MCCARRAN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6164
Mailing Address - Country:US
Mailing Address - Phone:775-825-8212
Mailing Address - Fax:775-825-7452
Practice Address - Street 1:6548 S MCCARRAN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6164
Practice Address - Country:US
Practice Address - Phone:775-825-8212
Practice Address - Fax:775-825-7452
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2010-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV122672084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G45950Medicare UPIN