Individual
JOHN R. KNUDSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6046 PORTAL WAY, STE 103, FERNDALE, WA 98248-7829
(360) 734-2330
(360) 733-3886
Mailing address
1260 MARALEE LANE, BELLINGHAM, WA 98226
(360) 393-4142
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
MD00013215
WA
208D00000X
General Practice Physician
MD00013215
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1466705
—
WA
01
—
151150
L&I
WA
01
—
50D0856491
CLIA
WA
01
—
5824KN
REG RYDER
WA
Enumeration date
10/04/2006
Last updated
03/07/2023
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