Provider Demographics
NPI:1457363673
Name:KNIBBE, WILLIAM PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PATRICK
Last Name:KNIBBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:W. PATRICK
Other - Middle Name:
Other - Last Name:KNIBBE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-383-0201
Mailing Address - Fax:208-489-4300
Practice Address - Street 1:600 N ROBBINS RD
Practice Address - Street 2:STE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4566
Practice Address - Country:US
Practice Address - Phone:208-383-0201
Practice Address - Fax:208-489-4300
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-8297207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20001206Medicare PIN