Basic Information
| Provider Information | |||||||||
| NPI: | 1417169954 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MINNIS | ||||||||
| FirstName: | JAMES | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 BON AIR RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LARKSPUR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949391143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4159242514 | ||||||||
| FaxNumber: | 4159242661 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 BON AIR RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LARKSPUR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949391143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4159242514 | ||||||||
| FaxNumber: | 4159242661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 09/20/2012 | ||||||||
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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 | 208600000X | 125-049901 | IL | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.