Individual
LUCAS KNOWLTON
Active
Individual
LUCAS KNOWLTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
4970
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA.200603
LA STATE BOARD OF MEDICAL EXAMINERS
LA
Enumeration date
09/20/2011
Last updated
08/06/2013
Update your record
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