Provider Demographics
NPI:1790858611
Name:KNOTTS, DONALD RICHARD (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:RICHARD
Last Name:KNOTTS
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20130 LAKE CHABOT RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5340
Mailing Address - Country:US
Mailing Address - Phone:510-886-3701
Mailing Address - Fax:510-537-3194
Practice Address - Street 1:20130 LAKE CHABOT RD
Practice Address - Street 2:SUITE 309
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5340
Practice Address - Country:US
Practice Address - Phone:510-886-3701
Practice Address - Fax:510-537-3194
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG33548207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G355480Medicaid
CA00G355480Medicare PIN
CA00G355480Medicaid