Provider Demographics
NPI:1295823979
Name:KNECHT, CLYDE ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:CLYDE
Middle Name:ALLEN
Last Name:KNECHT
Suffix:
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 1:403 UTAH AVE
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923
Mailing Address - Country:US
Mailing Address - Phone:406-293-8321
Mailing Address - Fax:406-293-8584
Practice Address - Street 1:403 UTAH AVE
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923
Practice Address - Country:US
Practice Address - Phone:406-293-8321
Practice Address - Fax:406-293-8584
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0054990Medicaid
C64243Medicare UPIN
MT0054990Medicaid