Provider Demographics
NPI:1205462819
Name:KNAPP, DEREK CURT (DPM STUDENT)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:CURT
Last Name:KNAPP
Suffix:
Gender:M
Credentials:DPM STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 CANADA VALLEY RD APT 165
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-9003
Mailing Address - Country:US
Mailing Address - Phone:208-705-2073
Mailing Address - Fax:
Practice Address - Street 1:4900 CANADA VALLEY RD APT 165
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-9003
Practice Address - Country:US
Practice Address - Phone:208-705-2073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-14
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty