1215095245 NPI number — MR. FRANKLIN R KNOWLTON OD,PLLC

Table of content: MR. FRANKLIN R KNOWLTON OD,PLLC (NPI 1215095245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215095245 NPI number — MR. FRANKLIN R KNOWLTON OD,PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNOWLTON
Provider First Name:
FRANKLIN
Provider Middle Name:
R
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
OD,PLLC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KNOWLTON
Provider Other First Name:
F
Provider Other Middle Name:
RENNY
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1215095245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
195 E GENTILE ST
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
LAYTON
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84041-3754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-546-2020
Provider Business Mailing Address Fax Number:
801-546-1237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
195 E GENTILE ST
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
LAYTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84041-3754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-546-2020
Provider Business Practice Location Address Fax Number:
801-546-1237
Provider Enumeration Date:
12/04/2006

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: 152W00000X , with the licence number:  1089469934 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1184917734 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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