Healthcare Provider Details

I. General information

NPI: 1417918038
Provider Name (Legal Business Name): JOSEPH JAY GUTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 12/15/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 MORRIS RD SUITE 2
SHELBY OH
44875-1170
US

IV. Provider business mailing address

1040 DELAWARE AVE
MARION OH
43302-6416
US

V. Phone/Fax

Practice location:
  • Phone: 419-347-4177
  • Fax:
Mailing address:
  • Phone: 740-383-7936
  • Fax: 740-375-8174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.064900
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number35.064900
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: