Provider Demographics
NPI:1972681740
Name:KNOBLICH, GUENTHER O (MD)
Entity Type:Individual
Prefix:
First Name:GUENTHER
Middle Name:O
Last Name:KNOBLICH
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 1:269 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1551
Mailing Address - Country:US
Mailing Address - Phone:541-482-4533
Mailing Address - Fax:
Practice Address - Street 1:269 MAPLE ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1551
Practice Address - Country:US
Practice Address - Phone:541-482-4533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62791207X00000X
ORMD27279207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A627910Medicaid
OR218173Medicaid
H53586Medicare UPIN
00A627910Medicare ID - Type Unspecified