Organization
GERALD L KNOUF MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALD L KNOUF MD (OWNER)
(208) 238-0400
Entity
Organization
Contact information
Practice address
190 W BURNSIDE AVE, STE C, CHUBBUCK, ID 83202-2411
(208) 023-8040
(208) 238-0401
Mailing address
190 W BURNSIDE AVE, STE C, CHUBBUCK, ID 83202
(208) 023-8040
(208) 238-0401
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11043901
MEDICARE PTAN
ID
Enumeration date
06/12/2009
Last updated
12/08/2021
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