MEDICARE: RONALD JOSEPH KNOBLOCK MD

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	207ZF0201X	Forensic Pathology Physician	10511	NV
2	207ZH0000X	Hematology (Pathology) Physician	10511	NV
3	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	10511	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669413084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD JOSEPH KNOBLOCK MD

Provider Business Mailing Address
First Line	:	11025 RCA CENTER DR STE 300
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4269
Country	:	US
Telephone Number	:	561-383-3820
Fax Number	:	855-369-2450

Provider Business Practice Location Address
First Line	:	7455 W WASHINGTON AVE STE 301
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128
Country	:	US
Telephone Number	:	877-562-5227
Fax Number	:	702-938-9954

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	06/12/2019

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