Healthcare Provider Details

I. General information

NPI: 1811265887
Provider Name (Legal Business Name): PAUL WILLIAM KNOOP M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 GREENSBURG CIR
RENO NV
89509-6833
US

IV. Provider business mailing address

1500 GREENSBURG CIR
RENO NV
89509-6833
US

V. Phone/Fax

Practice location:
  • Phone: 775-786-3628
  • Fax: 775-786-6638
Mailing address:
  • Phone: 775-786-3628
  • Fax: 775-786-6638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number2198
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2198
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: