Healthcare Provider Details

I. General information

NPI: 1164567848
Provider Name (Legal Business Name): EVAN R KNAUS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE SUITE 6600
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

201 CEDAR ST SE SUITE 6600
ALBUQUERQUE NM
87106
US

V. Phone/Fax

Practice location:
  • Phone: 505-724-4300
  • Fax: 505-724-4384
Mailing address:
  • Phone: 505-724-4300
  • Fax: 505-724-4384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number207006526
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA-1437-08
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA1437-08
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: