Provider Demographics
NPI:1376618827
Name:KNOBLICH, PETER J (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:KNOBLICH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9699 MOUNT VERNON RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-9758
Mailing Address - Country:US
Mailing Address - Phone:530-885-8595
Mailing Address - Fax:530-885-8595
Practice Address - Street 1:1158 CIRBY WAY STE B
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4422
Practice Address - Country:US
Practice Address - Phone:916-774-4348
Practice Address - Fax:916-774-1556
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG45768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG45768Medicare UPIN