MEDICARE: JACQUES HECTOR MINVILLE M.D.

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
1	2084P0800X	Psychiatry Physician	MD-9353	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00F0223880	OTHER	HI	HMSA
2	0050016700	OTHER	HI	ALOHA CARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083766224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUES HECTOR MINVILLE M.D.

Provider Business Mailing Address
First Line	:	43 BARKLEY CIR
Second Line	:	STE. 201
City	:	FORT MYERS
State	:	FL
Zip	:	33907-4510
Country	:	US
Telephone Number	:	239-936-5250
Fax Number	:	239-936-9970

Provider Business Practice Location Address
First Line	:	43 BARKLEY CIR
Second Line	:	STE. 201
City	:	FORT MYERS
State	:	FL
Zip	:	33907-4510
Country	:	US
Telephone Number	:	239-936-5250
Fax Number	:	239-936-9970

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	06/29/2015

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