Provider Demographics
NPI:1962448449
Name:KNUTSON, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:KNUTSON
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 1:257 COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-4400
Mailing Address - Country:US
Mailing Address - Phone:970-399-4200
Mailing Address - Fax:970-399-4219
Practice Address - Street 1:257 COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-4400
Practice Address - Country:US
Practice Address - Phone:970-399-4200
Practice Address - Fax:970-399-4219
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42654207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11733039Medicaid
COKN800809OtherBCBS
CO205549511002OtherROCKY MOUNTAIN HEALTH PLA
COC806696Medicare PIN
COH48867Medicare UPIN
CO205549511002OtherROCKY MOUNTAIN HEALTH PLA
CO11733039Medicaid
COKN800809OtherBCBS