Provider Demographics
NPI:1245230937
Name:KNOBLE, STEPHEN JOHN (PA-C)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JOHN
Last Name:KNOBLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:SD
Mailing Address - Zip Code:57442-1506
Mailing Address - Country:US
Mailing Address - Phone:605-765-2790
Mailing Address - Fax:605-765-2273
Practice Address - Street 1:608 E GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:SD
Practice Address - Zip Code:57442-1325
Practice Address - Country:US
Practice Address - Phone:605-765-2273
Practice Address - Fax:605-765-2273
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0290363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS6960OtherBCBS GROUP #
SD57584OtherMEDICARE B INDIVIDUAL #
SD4997560OtherINDIVIDUAL BCBS
SD4997849OtherGROUP BCBS
SD5350190Medicaid
SD6822152Medicaid
SD6822152Medicaid
SDS6960OtherBCBS GROUP #