Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 279343 | NY |
N | 207U00000X | Nuclear Medicine Specialist | MD439162 | PA |
NPI | 1275698243 |
---|---|
Provider Name | Dr. Mark Allen Mingos |
First Address | Sayre, PA 18840-1625 |
Second Address | Sayre, PA 18840-1625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 12/03/2021 |