Healthcare Provider Details

I. General information

NPI: 1679993265
Provider Name (Legal Business Name): EREZ ABRAHAM MINKA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4327 BARNETT RD
WICHITA FALLS TX
76310-2303
US

IV. Provider business mailing address

4327 BARNETT RD
WICHITA FALLS TX
76310-2303
US

V. Phone/Fax

Practice location:
  • Phone: 940-687-3376
  • Fax:
Mailing address:
  • Phone: 940-687-3376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberR5012
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberR5012
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberR5012
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberR5012
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOT015734
License Number StatePA
# 6
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberR5012
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: