Provider Demographics
NPI:1992895684
Name:KNOWLES, CLARENCE RICHARD (DO)
Entity type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:RICHARD
Last Name:KNOWLES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1900 S GNOME TRL
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-5665
Mailing Address - Country:US
Mailing Address - Phone:520-458-1696
Mailing Address - Fax:520-458-1696
Practice Address - Street 1:2240 WINROW RD
Practice Address - Street 2:
Practice Address - City:FORT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613-5080
Practice Address - Country:US
Practice Address - Phone:520-533-9143
Practice Address - Fax:520-533-9178
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2894208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics