Healthcare Provider Details

I. General information

NPI: 1962409938
Provider Name (Legal Business Name): THOMAS R. KNUTSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/29/2006

III. Provider practice location address

1955 CITRACADO PKWY SUITE 200
ESCONDIDO CA
92029-4110
US

IV. Provider business mailing address

15611 POMERADO RD FIFTH FLOOR
POWAY CA
92064-2437
US

V. Phone/Fax

Practice location:
  • Phone: 760-743-4789
  • Fax: 760-743-4779
Mailing address:
  • Phone: 858-673-2574
  • Fax: 858-618-1523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG50268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: