Provider Demographics
NPI:1447417951
Name:KNUDSON, AARON (DO)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:KNUDSON
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 1:601 NORTH NAVAJO DRIVE
Mailing Address - Street 2:
Mailing Address - City:PAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:86040
Mailing Address - Country:US
Mailing Address - Phone:928-645-0766
Mailing Address - Fax:928-645-0767
Practice Address - Street 1:601 N NAVAJO DRIVE
Practice Address - Street 2:POB 1447
Practice Address - City:PAGE
Practice Address - State:AZ
Practice Address - Zip Code:86040
Practice Address - Country:US
Practice Address - Phone:928-645-0766
Practice Address - Fax:928-645-0767
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005875207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics