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General NPI Number Information
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NPI Number | 1578767844
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Entity Type | Organization
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Legal Business Name | LEONARD D. GUTH MD PC
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 5424 N MARTHA LOOP
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City | COEUR D ALENE
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State | ID
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Zip | 83815-9143
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Country | US
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Telephone | 208-661-7037
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Fax |
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Provider Business Mailing Address
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Address Line | 5424 N MARTHA LOOP
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City | COEUR D ALENE
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State | ID
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Zip | 83815-9143
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEONARD D GUTH
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Credential | M.D.
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Telephone | 208-661-7037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | M5099
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License Number State | ID
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