Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 02005272A | IN |
Y | 111NI0900X | Internist | 02005272A | IN |
N | 208D00000X | General Practice Physician | 02005272A | IN |
NPI | 1043673395 |
---|---|
Provider Name | Dr. Mintcho Elinov Mintchev |
First Address | Jbsa Ft Sam Houston, TX 78234-4504 |
Second Address | Fort Sam Houston, TX 78234-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2016 |
Last Update Date | 18/12/2020 |