Healthcare Provider Details

I. General information

NPI: 1477045284
Provider Name (Legal Business Name): MATTHEW RYAN KNOUSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 CALLE PALMERAS STE 601
SAN JUAN PR
00901-2410
US

IV. Provider business mailing address

53 CALLE PALMERAS STE 601
SAN JUAN PR
00901-2410
US

V. Phone/Fax

Practice location:
  • Phone: 787-334-1435
  • Fax:
Mailing address:
  • Phone: 787-334-1435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberTPME5446
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD479088
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberT8248
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT215706
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMTL-2026-010
License Number StateGU
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberM-2527
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: