Individual
SCOTT K M KNUDSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
120 DESERT SAGE WAY, MOUNTAIN HOME, ID 83647-1038
(208) 587-3988
(208) 587-3324
Mailing address
120 DESERT SAGE WAY, MOUNTAIN HOME, ID 83647-1038
(208) 587-3988
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2589
ID
Other
Enumeration date
04/28/2021
Last updated
04/25/2024
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