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NPI Code Detail

MEDICARE: DON S MINCKLER MD

MEDICARE: DON S MINCKLER MD
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
1207ZP0101XAnatomic Pathology PhysicianG33305CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2WG33305DOTHERCAMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
300G333050OTHERCABLUE SHIELD

General Provider Information

NPI Number : 1245263060
Entity Type Code : Individual
Provider Name (Legal Business Name) : DON S MINCKLER MD
Provider Business Mailing Address
First Line : PO BOX 51055
Second Line :
City : LOS ANGELES
State : CA
Zip : 90051-5355
Country : US
Telephone Number : 714-456-8068
Fax Number : 714-456-3765
Provider Business Practice Location Address
First Line : 101 THE CITY DR S
Second Line :
City : ORANGE
State : CA
Zip : 92868-3201
Country : US
Telephone Number : 714-456-8068
Fax Number : 714-456-3765
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2006
Last Update Date : 09/26/2019

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Directions to “ DON S MINCKLER MD” Practice Location

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