Healthcare Provider Details

I. General information

NPI: 1568584571
Provider Name (Legal Business Name): JAMES ALAN KNUTSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 6TH ST S
KIRKLAND WA
98033-6714
US

IV. Provider business mailing address

830 6TH ST S
KIRKLAND WA
98033-6714
US

V. Phone/Fax

Practice location:
  • Phone: 425-828-0543
  • Fax: 425-821-8693
Mailing address:
  • Phone: 425-828-0543
  • Fax: 425-821-8693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMD00033603
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: