Individual
DR. CLARK JON KNUTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
151 BRIDGE STREET, PLATTSBURGH, NY 12901
(518) 561-7337
(518) 561-1335
Mailing address
151 BRIDGE STREET, PLATTSBURGH, NY 12901
(518) 561-7337
(518) 561-1335
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2128611
NY
208000000X
Pediatrics Physician
35C001716
OH
208M00000X
Hospitalist Physician
35C001716
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000490822003
BSNNY
NY
05
—
0054654
—
OH
05
—
01908429
—
NY
Enumeration date
10/06/2006
Last updated
08/01/2024
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