Provider Demographics
NPI:1841293354
Name:GUESS, KEITH BRYAN (PA)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:BRYAN
Last Name:GUESS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-335-8370
Mailing Address - Fax:319-335-7247
Practice Address - Street 1:4189 WESTLAWN S
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1100
Practice Address - Country:US
Practice Address - Phone:319-335-8370
Practice Address - Fax:319-335-7247
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-001376363A00000X
IA001170363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL421527584002Medicaid
421527584OtherTRI-CARE
42152758406OtherJOHN DEERE
IA0278374Medicaid
IA0563882Medicaid
IA161816Medicare Oscar/Certification
IL141934Medicare Oscar/Certification
IA0278374Medicaid
IA0563882Medicaid
IL203628Medicare PIN