Provider Demographics
NPI:1619960523
Name:KNODEL, ARTHUR RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:RAYMOND
Last Name:KNODEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:SUITE 401
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4252
Mailing Address - Country:US
Mailing Address - Phone:253-572-5140
Mailing Address - Fax:253-272-0419
Practice Address - Street 1:316 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:SUITE 401
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4252
Practice Address - Country:US
Practice Address - Phone:253-572-5140
Practice Address - Fax:253-272-0419
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020126207R00000X, 207RP1001X, 207RC0200X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1003011Medicaid
WA290001644OtherRR MEDICARE
WAG001001518-PIERCE COMedicare PIN
WA290001644OtherRR MEDICARE
WAA08725Medicare UPIN