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General NPI Number Information
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NPI Number | 1386278695
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Entity Type | Individual
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Provider Name | CODY MINOR MD
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Gender | Male
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Dates
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Enumeration Date | 02/25/2020
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 77 NEALY AVE
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City | HAMPTON
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State | VA
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Zip | 23665-2040
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Country | US
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Telephone | 757-225-7630
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Fax |
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Provider Business Mailing Address
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Address Line | 4881 SUGAR MAPLE DR
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City | WRIGHT PAT
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State | OH
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Zip | 45433-5529
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Country | US
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Telephone | 937-257-2778
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35622
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License Number State | NE
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