MEDICARE: ROBERT KNUTSON PA-C

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	363A00000X	Physician Assistant	MK4712750	CO
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1386142313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT KNUTSON PA-C

Provider Business Mailing Address
First Line	:	2820 JAVA CT
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-4257
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6900 E 47TH AVENUE DR STE 100
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80216-3449
Country	:	US
Telephone Number	:	303-333-4411
Fax Number	:

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

Provider Enumeration Date	:	01/24/2018
Last Update Date	:	02/04/2019

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