Healthcare Provider Details

I. General information

NPI: 1083885040
Provider Name (Legal Business Name): KARL R KNUDSEN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 BRYANT WILLIAMS DR SUITE 1
KLAMATH FALLS OR
97601-1120
US

IV. Provider business mailing address

2200 BRYANT WILLIAMS DR SUITE 1
KLAMATH FALLS OR
97601-1120
US

V. Phone/Fax

Practice location:
  • Phone: 541-884-7746
  • Fax: 541-884-0848
Mailing address:
  • Phone: 541-884-7746
  • Fax: 541-884-0848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD227448
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD27448
License Number StateOR

VIII. Authorized Official

Name: JEANNETTE GANSBERG
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 541-274-2902