Provider Demographics
NPI:1780979914
Name:KNAPP, STUART G (MD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:G
Last Name:KNAPP
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 1:44 N 1ST E
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:ID
Mailing Address - Zip Code:83263-1326
Mailing Address - Country:US
Mailing Address - Phone:208-852-3662
Mailing Address - Fax:208-852-1295
Practice Address - Street 1:47 N 1ST E
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:ID
Practice Address - Zip Code:83263
Practice Address - Country:US
Practice Address - Phone:208-852-2900
Practice Address - Fax:208-852-3511
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM12473207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1780979914Medicaid
IDM-12473OtherMEDICAL LICENSE
IN201095620Medicaid