MEDICARE: JONATHAN ANDREW MINES 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
1	207W00000X	Ophthalmology Physician	ME0053537	FL
2	207WX0107X	Retina Specialist (Ophthalmology) Physician	ME0053537	FL

General Provider Information

NPI Number	:	1366405326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN ANDREW MINES MD

Provider Business Mailing Address
First Line	:	403 VONDERBURG DR
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-5501
Country	:	US
Telephone Number	:	813-681-1122
Fax Number	:	813-684-4924

Provider Business Practice Location Address
First Line	:	13106 VAIL RIDGE DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-7187
Country	:	US
Telephone Number	:	813-392-3311
Fax Number	:	813-392-3301

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	05/13/2025

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