Healthcare Provider Details

I. General information

NPI: 1497959001
Provider Name (Legal Business Name): LAURA MICHELLE KNUTSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA MICHELLE SMITH

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

14531 NW 21ST PL
NEWBERRY FL
32669-2041
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0111
  • Fax:
Mailing address:
  • Phone: 352-332-9747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTRN1145
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: