Healthcare Provider Details

I. General information

NPI: 1174512305
Provider Name (Legal Business Name): THOMAS JOHN KNOLMAYER M.D.,F.A.C.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 DEBARR RD SUITE 290
ANCHORAGE AK
99508-2952
US

IV. Provider business mailing address

19510 S MITKOF LOOP
EAGLE RIVER AK
99577-8669
US

V. Phone/Fax

Practice location:
  • Phone: 907-276-1046
  • Fax: 907-222-6898
Mailing address:
  • Phone: 907-696-2704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4492
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: