Individual
JACOB R DUTCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 SIXTH AVE N, ST CLOUD, MN 56303-2735
(320) 656-7020
Mailing address
1200 SIXTH AVE N, ST CLOUD, MN 56303-2735
(320) 656-7020
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
102900
MN
207RC0000X
Cardiovascular Disease Physician
43641
MN
207RI0011X
Interventional Cardiology Physician
Primary
43641
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NPI
—
MN
Enumeration date
03/14/2007
Last updated
03/06/2015
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