Provider Demographics
NPI:1659447290
Name:KNAUS, GARY D (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:D
Last Name:KNAUS
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 1:1340 HIGHWAY 133
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-1933
Mailing Address - Country:US
Mailing Address - Phone:970-963-3350
Mailing Address - Fax:970-963-2958
Practice Address - Street 1:1340 HIGHWAY 133
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-1933
Practice Address - Country:US
Practice Address - Phone:970-963-3350
Practice Address - Fax:970-963-2958
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01202076Medicaid
AK7131078OtherDEA
COC83424Medicare PIN
AK7131078OtherDEA