Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 46965 | AZ |
N | 207X00000X | Orthopaedic Surgeon | PENDING | NY |
N | 207XS0117X | Orthopaedic Spine Surgeon | 45372 | KY |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 46965 | AZ |
N | 208D00000X | General Practice Physician | 45372 | KY |
NPI | 1366618530 |
---|---|
Provider Name | Mr. Curis Andrew Mina |
First Address | Palmer, AK 99645 |
Second Address | Palmer, AK 99645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2008 |
Last Update Date | 24/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201126490 | (05) | IN |
7100221430 | (05) | KY |
775162 | ANTHEM-NNLSC (01) | KY |
K058580 | MEDICARE- NLSC (01) | KY |