Healthcare Provider Details

I. General information

NPI: 1295738839
Provider Name (Legal Business Name): ALAN FRANKLIN KNULL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 LEE HWY N
PULASKI VA
24301-2326
US

IV. Provider business mailing address

2400 LEE HWY N
PULASKI VA
24301-2326
US

V. Phone/Fax

Practice location:
  • Phone: 540-994-8483
  • Fax: 540-994-8392
Mailing address:
  • Phone: 540-994-8483
  • Fax: 540-994-8392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101036807
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: