Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 6381-C | AL |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 6381-C | AL |
NPI | 1578855078 |
---|---|
Provider Name | David G Minto JR. |
First Address | Fairhope, AL 36532-3836 |
Second Address | Fairhope, AL 36532-3836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2011 |
Last Update Date | 24/04/2019 |