MEDICARE: CLAUDE B MINOR JR APMC

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	174400000X	Specialist	017426	LA

General Provider Information

NPI Number	:	1679745798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLAUDE B MINOR JR APMC

Provider Business Mailing Address
First Line	:	2806 MARK DR
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-5152
Country	:	US
Telephone Number	:	318-388-2996
Fax Number	:	318-388-2998

Provider Business Practice Location Address
First Line	:	2806 MARK DR
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-5152
Country	:	US
Telephone Number	:	318-388-2996
Fax Number	:	318-388-2998

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CLAUDE BARRETT MINOR JR.
Credential	:	M.D.
Telephone Number	:	318-388-2996

Provider Enumeration Date	:	03/28/2008
Last Update Date	:	03/28/2008

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