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NPI Code Detail

MEDICARE: DR. D EDWARD MINEAU M.D.

MEDICARE: DR. D EDWARD MINEAU 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
12085R0202XDiagnostic Radiology Physician152665-1205UT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
6P00651547OTHERUTRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669472320
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. D EDWARD MINEAU M.D.
Provider Business Mailing Address
First Line : PO BOX 1369
Second Line :
City : BOUNTIFUL
State : UT
Zip : 84011-1369
Country : US
Telephone Number : 801-296-2113
Fax Number : 801-296-1715
Provider Business Practice Location Address
First Line : 1200 E 3900 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84124-1300
Country : US
Telephone Number : 801-268-7111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2005
Last Update Date : 02/12/2009

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Directions to “ DR. D EDWARD MINEAU M.D.” Practice Location

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