Provider Demographics
NPI:1497878201
Name:KNUTSON, TIMOTHY LAWRENCE (DPM)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LAWRENCE
Last Name:KNUTSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 E SOUTHCROSS BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-3521
Mailing Address - Country:US
Mailing Address - Phone:210-333-7405
Mailing Address - Fax:210-333-7451
Practice Address - Street 1:3875 E SOUTHCROSS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-3521
Practice Address - Country:US
Practice Address - Phone:210-333-7405
Practice Address - Fax:210-333-7451
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0764213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018799901Medicaid
TXT14234Medicare UPIN
TX018799901Medicaid