Healthcare Provider Details

I. General information

NPI: 1740282490
Provider Name (Legal Business Name): MARK ALLEN CIMINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 HOMER RD
MINDEN LA
71055-3027
US

IV. Provider business mailing address

1111 HOMER RD
MINDEN LA
71055-3027
US

V. Phone/Fax

Practice location:
  • Phone: 318-377-7500
  • Fax: 318-377-2324
Mailing address:
  • Phone: 318-377-7500
  • Fax: 318-377-2324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15018R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE3519
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE3519
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: