Provider Demographics
NPI:1174538912
Name:KNABLE, ALFRED L JR (MD)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:L
Last Name:KNABLE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950132
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0132
Mailing Address - Country:US
Mailing Address - Phone:888-980-8992
Mailing Address - Fax:
Practice Address - Street 1:2241 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150
Practice Address - Country:US
Practice Address - Phone:812-948-1148
Practice Address - Fax:812-948-0032
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041935207N00000X
KY33806207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64338064Medicaid
IN200195570Medicaid
IN199740Medicare ID - Type Unspecified
IN200195570Medicaid
KY64338064Medicaid
0096017Medicare PIN