MEDICARE: DR. DARIN MARSHALL MINKIN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	2000170421	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043296494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARIN MARSHALL MINKIN D.O.

Provider Business Mailing Address
First Line	:	2355 DOUGHERTY FERRY RD
Second Line	:	430
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-3325
Country	:	US
Telephone Number	:	314-965-8410
Fax Number	:	314-965-8756

Provider Business Practice Location Address
First Line	:	2355 DOUGHERTY FERRY RD
Second Line	:	430
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122
Country	:	US
Telephone Number	:	314-965-8410
Fax Number	:	314-965-8756

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	09/13/2013

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