Provider Demographics
NPI:1013088327
Name:KNAUFF, TIMOTHY R (PAC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:R
Last Name:KNAUFF
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 530010
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89053-0010
Mailing Address - Country:US
Mailing Address - Phone:702-492-7208
Mailing Address - Fax:702-616-0657
Practice Address - Street 1:9975 S EASTERN AVE STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-7950
Practice Address - Country:US
Practice Address - Phone:702-492-7208
Practice Address - Fax:702-616-0657
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV619363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1013088327Medicaid
NVVAT196ZMedicare PIN
NV1013088327Medicaid