MEDICARE: GERARD JEROME MINOR PA-C

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	363A00000X	Physician Assistant	PA09101834	FL

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	:	1942368535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERARD JEROME MINOR PA-C

Provider Business Mailing Address
First Line	:	5955 PONCE DE LEON BLVD.
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-2423
Country	:	US
Telephone Number	:	305-661-1515
Fax Number	:	305-662-3723

Provider Business Practice Location Address
First Line	:	3800 JOHNSON ST STE J
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6030
Country	:	US
Telephone Number	:	954-967-9400
Fax Number	:	833-464-4211

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/16/2025

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