Provider Demographics
NPI:1255310850
Name:KNORR, DAVID J (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:KNORR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:MO
Mailing Address - Zip Code:63461-1961
Mailing Address - Country:US
Mailing Address - Phone:573-769-2231
Mailing Address - Fax:573-769-3953
Practice Address - Street 1:1811 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:MO
Practice Address - Zip Code:63461-1961
Practice Address - Country:US
Practice Address - Phone:573-769-2231
Practice Address - Fax:573-769-3953
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001001473207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO245289400Medicaid
MO003013771Medicare ID - Type Unspecified
MO245289400Medicaid