Provider Demographics
NPI:1972118016
Name:GINTHER, JACOB
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:GINTHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S 2ND ST STE 180
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-5000
Mailing Address - Country:US
Mailing Address - Phone:612-626-1500
Mailing Address - Fax:612-626-8311
Practice Address - Street 1:1300 S 2ND ST STE 180
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-5000
Practice Address - Country:US
Practice Address - Phone:612-626-1500
Practice Address - Fax:612-626-8311
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14328363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant