Provider Demographics
NPI:1255317038
Name:KNUDTSON, JASON (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:KNUDTSON
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 1:9399 CROWN CREST BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8508
Mailing Address - Country:US
Mailing Address - Phone:303-805-1855
Mailing Address - Fax:303-808-4421
Practice Address - Street 1:9399 CROWN CREST BLVD STE 220
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8508
Practice Address - Country:US
Practice Address - Phone:303-805-1855
Practice Address - Fax:303-805-4421
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219949208600000X
SD8793208600000X
KS04-292192086S0102X
CO49459208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2043840Medicaid
MA53636Medicare UPIN
MAA37013Medicare ID - Type Unspecified