Provider Demographics
NPI:1700813441
Name:KNUDSON, GARY A (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:KNUDSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2101 KIMBALL AVE
Mailing Address - Street 2:LL14
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5063
Mailing Address - Country:US
Mailing Address - Phone:319-272-1590
Mailing Address - Fax:319-272-1535
Practice Address - Street 1:2710 SAINT FRANCIS DR
Practice Address - Street 2:SUITE 319
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5619
Practice Address - Country:US
Practice Address - Phone:319-272-5000
Practice Address - Fax:391-272-4780
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-16
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Provider Licenses
StateLicense IDTaxonomies
IA32397207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1957670Medicaid
IA1957670Medicaid
IA45115Medicare PIN