MEDICARE: EVA S MINA 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	207R00000X	Internal Medicine Physician	K8344	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1891784922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVA S MINA M.D.

Provider Business Mailing Address
First Line	:	479 WESTPARK WAY
Second Line	:
City	:	EULESS
State	:	TX
Zip	:	76040-3957
Country	:	US
Telephone Number	:	817-358-5500
Fax Number	:	817-358-5511

Provider Business Practice Location Address
First Line	:	3100 NORTH TARRANT PARKWAY #104
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-8616
Country	:	US
Telephone Number	:	817-358-5500
Fax Number	:	817-358-5511

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	04/28/2016

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Directions to “ EVA S MINA M.D.” Practice Location

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