Active NPI
Wallace H Knapp, M.D.
- Dermatology Physician
- Corvallis, OR
National Provider Identifier
1972553220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- MD07935
- Practice address
- 444 NW Elks Dr
Corvallis, OR 97330-3745 - Phone
- (541) 754-1150
- NPI assigned
- May 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | MD07935 | OR | Primary |
Addresses
Primary practice location
444 NW Elks Dr
Corvallis, OR 97330-3745
Mailing address
444 NW Elks Dr
Corvallis, OR 97330-3745
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 242669 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD07935 | OR | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244160000000",
"number": "1972553220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "444 NW ELKS DR",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973303745"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "444 NW ELKS DR",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973303745",
"telephone_number": "541-754-1150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KNAPP",
"first_name": "WALLACE",
"middle_name": "H",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-10",
"last_updated": "2009-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "OR",
"license": "MD07935",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "242669",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corvallis, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.