Provider Demographics
NPI:1881661734
Name:GUTHRIE, RICHARD BERNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BERNIE
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 PHALEN BLVD
Mailing Address - Street 2:# 109
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-3679
Mailing Address - Country:US
Mailing Address - Phone:651-271-3697
Mailing Address - Fax:
Practice Address - Street 1:1355 PHALEN BLVD
Practice Address - Street 2:# 109
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-3679
Practice Address - Country:US
Practice Address - Phone:651-271-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20562207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31283300Medicaid
MN020285100Medicaid
MN060000102Medicare ID - Type UnspecifiedMN MEDICARE
MN020285100Medicaid