Provider Demographics
NPI:1629057542
Name:GUTH, DAVID EARL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EARL
Last Name:GUTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6010
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59406-6010
Mailing Address - Country:US
Mailing Address - Phone:406-455-4470
Mailing Address - Fax:406-268-0084
Practice Address - Street 1:1300 11TH AVE S
Practice Address - Street 2:14
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5315
Practice Address - Country:US
Practice Address - Phone:406-771-1172
Practice Address - Fax:406-268-0084
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT3900208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1629057542Medicaid
MT1629057542Medicaid
MT011002409Medicare UPIN
MTD90264Medicare UPIN