Provider Demographics
NPI:1801981485
Name:KNORR, PHILIP ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ANDREW
Last Name:KNORR
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 1:65 NEILSON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2491
Mailing Address - Country:US
Mailing Address - Phone:831-728-4227
Mailing Address - Fax:831-728-0410
Practice Address - Street 1:160 GREEN VALLEY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-3160
Practice Address - Country:US
Practice Address - Phone:831-728-4227
Practice Address - Fax:831-728-0410
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56315208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1437599032Medicaid
00G563150Medicare PIN