Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | D23417 | MD |
NPI | 1033290010 |
---|---|
Provider Name | Dr. John Shreve Minkowski |
First Address | Towson, MD 21286-2352 |
Second Address | Saint Simons Island, GA 31522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 24/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
366001000 | (05) | MD |
D76671 | (02) |