Provider Demographics
NPI:1730275736
Name:KNUDSEN, KARL R (MD)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:R
Last Name:KNUDSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2200 BRYANT WILLIAMS DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1121
Mailing Address - Country:US
Mailing Address - Phone:541-884-7746
Mailing Address - Fax:541-884-0848
Practice Address - Street 1:2200 BRYANT WILLIAMS DR
Practice Address - Street 2:SUITE 1
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1121
Practice Address - Country:US
Practice Address - Phone:541-884-7746
Practice Address - Fax:541-884-0848
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD27448207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR93062096697601OtherTRICARE
ORP00478530OtherRAIL ROAD MEDICARE
OR891400000OtherBLUE CROSS OF OREGON
OR26220204497601A002OtherTRICARE
ORP00419800OtherRAIL ROAD MEDICARE
OR002635014OtherBLUE CROSS
OR274622Medicaid
ORP00478530OtherRAIL ROAD MEDICARE
OR274622Medicaid
OR891400000OtherBLUE CROSS OF OREGON
OR0226190001Medicare NSC
OR6148550001Medicare NSC