Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | E5858 | TX |
NPI | 1023013612 |
---|---|
Provider Name | Dr. Michael Lewis Mintz |
First Address | Corpus Christi, TX 78466-6282 |
Second Address | Corpus Christi, TX 78411-1821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 08/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
122554204 | (05) | TX |
C19443 | (02) | TX |