Individual
DR. JACOB COOPER DEWEERTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2450 RIVERSIDE AVE, MINNEAPOLIS, MN 55454-1450
(612) 672-6000
Mailing address
1 VETERANS DRIVE, DEPARTMENT OF REHABILITATION AND PHYSICAL MEDICINE, MINNEAPOLIS, MN 55417-2309
(612) 467-4646
(612) 467-2333
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
65497
MN
207LP2900X
Pain Medicine (Anesthesiology) Physician
65497
MN
208VP0000X
Pain Medicine Physician
Primary
65497
MN
Other
Enumeration date
04/15/2014
Last updated
02/05/2025
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