Provider Demographics
NPI:1700971223
Name:KNOLL, JAMES LYLE III (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LYLE
Last Name:KNOLL
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2295 BACKCOUNTRY DR.
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147
Mailing Address - Country:US
Mailing Address - Phone:970-731-4262
Mailing Address - Fax:970-731-4262
Practice Address - Street 1:2295 BACKCOUNTRY DR.
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147
Practice Address - Country:US
Practice Address - Phone:970-731-4262
Practice Address - Fax:970-731-4262
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO346932084P0800X
CAC534092084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry