Healthcare Provider Details

I. General information

NPI: 1205462819
Provider Name (Legal Business Name): DEREK CURT KNAPP DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2020
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 BENCH RD STE B
POCATELLO ID
83201-2444
US

IV. Provider business mailing address

4512 POCAHONTAS DR
CHUBBUCK ID
83202-1745
US

V. Phone/Fax

Practice location:
  • Phone: 208-705-2073
  • Fax:
Mailing address:
  • Phone: 208-705-2073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number9881812
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: