Provider Demographics
NPI:1255589073
Name:D PAUL KNAPP
Entity type:Organization
Organization Name:D PAUL KNAPP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-273-5423
Mailing Address - Street 1:718 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3319
Mailing Address - Country:US
Mailing Address - Phone:760-337-8500
Mailing Address - Fax:760-337-8572
Practice Address - Street 1:1516 MAIN ST
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-5242
Practice Address - Country:US
Practice Address - Phone:760-789-6434
Practice Address - Fax:760-788-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33943207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC38720Medicare UPIN
CAWG33943AMedicare PIN
CAW11965Medicare PIN