Healthcare Provider Details

I. General information

NPI: 1831630540
Provider Name (Legal Business Name): JAMES A KNOTT MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

6600 E 2ND ST
CASPER WY
82609-4348
US

IV. Provider business mailing address

742 S DAVID ST
CASPER WY
82601-3137
US

V. Phone/Fax

Practice location:
  • Phone: 307-234-9657
  • Fax: 307-234-0306
Mailing address:
  • Phone: 307-234-9657
  • Fax: 307-234-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number6579A
License Number StateWY

VIII. Authorized Official

Name: JAMES A KNOTT
Title or Position: PRESIDENT
Credential: MD
Phone: 307-259-8186