Healthcare Provider Details

I. General information

NPI: 1295678233
Provider Name (Legal Business Name): JACOB GUTMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FISHER ST RM 1G123
BILOXI MS
39534-2508
US

IV. Provider business mailing address

301 FISHER ST RM 1G123
BILOXI MS
39534-2508
US

V. Phone/Fax

Practice location:
  • Phone: 228-376-3728
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberT-5978
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: