Healthcare Provider Details

I. General information

NPI: 1538214184
Provider Name (Legal Business Name): DANIEL STEWART KNORPP D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3217 BAVARIA STREET
EAGLE ID
83616-5171
US

IV. Provider business mailing address

3340 E GOLDSTONE WAY
MERIDIAN ID
83642-1026
US

V. Phone/Fax

Practice location:
  • Phone: 208-286-6676
  • Fax: 208-947-6676
Mailing address:
  • Phone: 208-286-6676
  • Fax: 208-947-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberO-0483
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: