Basic Information
| Provider Information | |||||||||
| NPI: | 1356441356 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MINOR | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8620 N 22ND AVE | ||||||||
| Address2: | #200 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026746501 | ||||||||
| FaxNumber: | 6026746512 | ||||||||
| Practice Location | |||||||||
| Address1: | 7725 N 43RD AVE | ||||||||
| Address2: | STE 720 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850515770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6234351923 | ||||||||
| FaxNumber: | 6234351924 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 08/26/2008 | ||||||||
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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 | 207Q00000X | 2321 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 271924 | 05 | AZ | MEDICAID |