Provider Demographics
NPI:1942577523
Name:RONALD E. GUTH M. D. INC.
Entity Type:Organization
Organization Name:RONALD E. GUTH M. D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:GUTH
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:707-462-6310
Mailing Address - Street 1:1285 VISTA VERDE RD
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-7554
Mailing Address - Country:US
Mailing Address - Phone:707-462-6310
Mailing Address - Fax:
Practice Address - Street 1:1285 VISTA VERDE RD
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-7554
Practice Address - Country:US
Practice Address - Phone:707-462-6310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44960207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G449600Medicaid
CA00G449600Medicaid
CA00G449600Medicare PIN