MEDICARE: RALPH WILLIAM KNAPP M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	1618901205	UT

General Provider Information

NPI Number	:	1073674768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RALPH WILLIAM KNAPP M.D.

Provider Business Mailing Address
First Line	:	410 CYNTHIA WAY
Second Line	:
City	:	NORTH SALT LAKE
State	:	UT
Zip	:	84054-1763
Country	:	US
Telephone Number	:	801-860-5052
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 W CENTER ST
Second Line	:
City	:	NORTH SALT LAKE
State	:	UT
Zip	:	84054-2917
Country	:	US
Telephone Number	:	801-936-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	10/10/2012

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