Basic Information
| Provider Information | |||||||||
| NPI: | 1073568812 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MINCE | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | MARTIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 MEDICAL CENTER DR SW | ||||||||
| Address2: | |||||||||
| City: | FORT PAYNE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359683421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2569972820 | ||||||||
| FaxNumber: | 2569972890 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 MEDICAL CENTER DR SW | ||||||||
| Address2: | |||||||||
| City: | FORT PAYNE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359683421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2569972820 | ||||||||
| FaxNumber: | 2569972890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 03/20/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 00010888 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 051534799 | 05 | AL | MEDICAID | 515-33800 | 01 | AL | BCBS | OTHER | 051533800 | 05 | AL | MEDICAID | 515-34799 | 01 | AL | BCBS | OTHER |