Healthcare Provider Details

I. General information

NPI: 1003887431
Provider Name (Legal Business Name): RANDALL K MINION MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 AVENUE M W
FORT DODGE IA
50501-5789
US

IV. Provider business mailing address

211 AVENUE M W STE A
FORT DODGE IA
50501-5789
US

V. Phone/Fax

Practice location:
  • Phone: 515-576-7261
  • Fax:
Mailing address:
  • Phone: 515-576-7261
  • Fax: 515-955-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33067
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number10606
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: