Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | ME0031596 | FL |
NPI | 1053386342 |
---|---|
Provider Name | Mark A. Mintz |
First Address | Fort Myers, FL 33907-1412 |
Second Address | Cape Coral, FL 33990 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 26/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
038588300 | (05) | FL |
1193412 | WELLCARE (01) | FL |
1262065-010 | CIGNA PROVIDER NUMBER (01) | FL |
202216 | AMERIGROUP PROVIDER NUM. (01) | FL |
256184 | USA MNGD. CR. PROVIDER # (01) | FL |
277536 | AVMED PROVIDER NUMBER (01) | FL |
4197070 | AETNA PROVIDER NUMBER (01) | FL |
68175 | OP. ENGIN. PROVIDER # (01) | FL |
709333 | FIRST HLTH/CCN PROVIDER # (01) | FL |
79302 | BCBS PROVIDER NUMBER (01) | FL |
D67273 | (02) | FL |
ME0031596 | METCARE PROVIDER NUMBER (01) | FL |