Provider Demographics
NPI:1497869648
Name:KNAPP, ANDREW L (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:L
Last Name:KNAPP
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:PO BOX 994307
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-4307
Mailing Address - Country:US
Mailing Address - Phone:530-241-2151
Mailing Address - Fax:
Practice Address - Street 1:2770 EUREKA WAY, SUITE 100
Practice Address - Street 2:PHYSICIANS WOUND CENTER
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-241-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6460207P00000X, 207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX64600Medicaid
F43311Medicare UPIN
CA00AX64600Medicaid