1477752236 NPI number — DR. LAURA ARLENE KNECHT M.D.

Table of content: MICHAEL WALTS MD (NPI 1093865883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477752236 NPI number — DR. LAURA ARLENE KNECHT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNECHT
Provider First Name:
LAURA
Provider Middle Name:
ARLENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVIES
Provider Other First Name:
LAURA
Provider Other Middle Name:
ARLENE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477752236
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6725 E DOVE VALLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAVE CREEK
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85331-5305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-524-3758
Provider Business Mailing Address Fax Number:
774-209-4329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6725 E DOVE VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAVE CREEK
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85331-5305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-524-3758
Provider Business Practice Location Address Fax Number:
774-209-4329
Provider Enumeration Date:
07/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  31996 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 236516 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".