Provider Demographics
NPI:1487688982
Name:KNUTSON, GENE C (DMP)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:C
Last Name:KNUTSON
Suffix:
Gender:M
Credentials:DMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 PACIFIC AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-7050
Mailing Address - Country:US
Mailing Address - Phone:253-473-5566
Mailing Address - Fax:253-882-0988
Practice Address - Street 1:7800 PACIFIC AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-7050
Practice Address - Country:US
Practice Address - Phone:253-473-5566
Practice Address - Fax:253-882-0988
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000432213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1054071Medicaid
WA44999OtherLABOR & INDUSTRIES
WA1054071Medicaid
WA1002549Medicare ID - Type Unspecified