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NPI Code Detail

MEDICARE: STEPHANIE MINTER DO

MEDICARE: STEPHANIE MINTER DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12083P0011XUndersea and Hyperbaric Medicine (Preventive Medicine) PhysicianUO5536FL
2225700000XMassage TherapistMA48493FL
3390200000XStudent in an Organized Health Care Education/Training Program
4207R00000XInternal Medicine PhysicianUO5536FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043581523
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE MINTER DO
Provider Business Mailing Address
First Line : 606 3RD AVE W APT 324
Second Line :
City : BRADENTON
State : FL
Zip : 34205-8679
Country : US
Telephone Number : 813-629-2622
Fax Number :
Provider Business Practice Location Address
First Line : 4401 CORTEZ RD W
Second Line :
City : BRADENTON
State : FL
Zip : 34210-3142
Country : US
Telephone Number : 941-357-5550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2012
Last Update Date : 11/14/2022

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