Healthcare Provider Details

I. General information

NPI: 1902986276
Provider Name (Legal Business Name): LESTER J MINTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 N I H 35 SUITE 200
AUSTIN TX
78753-5751
US

IV. Provider business mailing address

8401 N I H 35 SUITE 200
AUSTIN TX
78753-5751
US

V. Phone/Fax

Practice location:
  • Phone: 512-250-1005
  • Fax: 512-250-1066
Mailing address:
  • Phone: 512-250-1005
  • Fax: 512-250-1066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG1719
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: