Individual
MR. JACOB GREGORY GUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.C
Contact information
Practice address
1835 COUNTY ROAD C WEST, SUITE 150, STILLWATER, MN 55082-5078
(651) 259-4501
(651) 430-1447
Mailing address
1950 NORTHWESTERN AVE S STE 102, STILLWATER, MN 55082-7615
(651) 430-3800
(651) 430-3827
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
393
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0124329
MEDICA
MN
01
—
1047498
PREFERRED ONE
MN
01
—
135584
UCARE
MN
01
—
2443375
AMERICAS PPO
MN
05
—
42886700
—
WI
01
—
527G9GU
BLUE CROSS & BLUE SHIELD
MN
05
—
747410500
—
MN
01
—
HP65749
HEALTH PARTNERS
MN
Enumeration date
06/08/2006
Last updated
03/11/2021
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