Basic Information
| Provider Information | |||||||||
| NPI: | 1588659049 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MINTON | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7471 N FRESNO ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937202457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594364500 | ||||||||
| FaxNumber: | 5594360500 | ||||||||
| Practice Location | |||||||||
| Address1: | 2021 HERNDON AVE | ||||||||
| Address2: | STE. 101 | ||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936116101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597974315 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2005 | ||||||||
| LastUpdateDate: | 02/26/2017 | ||||||||
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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 | G42221 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | ZZZ21572Z | 01 | CA | PTAN FOR ALL OFFICE LOCATIONS: BAZ ALLERGY, ASTHMA & SINUS CENTER | OTHER | 00G422210 | 05 | CA | MEDICAID | GR0043790 | 05 | CA | MEDICAID |