Healthcare Provider Details

I. General information

NPI: 1356441356
Provider Name (Legal Business Name): DAVID D MINOR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7725 N 43RD AVE STE 720
PHOENIX AZ
85051-5770
US

IV. Provider business mailing address

8620 N 22ND AVE #200
PHOENIX AZ
85021
US

V. Phone/Fax

Practice location:
  • Phone: 623-435-1923
  • Fax: 623-435-1924
Mailing address:
  • Phone: 602-674-6501
  • Fax: 602-674-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2321
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: