Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME0069915 | FL |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | ME0069915 | FL |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | ME0069915 | FL |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | ME69915 | FL |
NPI | 1457350191 |
---|---|
Provider Name | Dr. Craig M. Mintzer |
First Address | Orlando, FL 32810-5915 |
Second Address | Orlando, FL 32810-5915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2005 |
Last Update Date | 24/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200030016 | RAILROAD (01) | FL |
256998100 | (05) | FL |
42256 | BC/BS (01) | FL |
G59472 | (02) | FL |