MEDICARE: MARK W MINOR MD

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	207KA0200X	Allergy Physician	ME0045859	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1762243003	OTHER	FL	CIGNA
2	4038851	OTHER	FL	AETNA
3	26075	OTHER	FL	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982609657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK W MINOR MD

Provider Business Mailing Address
First Line	:	3021 W EAU GALLIE BLVD STE 102
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32934-7005
Country	:	US
Telephone Number	:	321-757-5550
Fax Number	:	321-255-5552

Provider Business Practice Location Address
First Line	:	3021 W EAU GALLIE BLVD STE 102
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32934-7005
Country	:	US
Telephone Number	:	321-757-5550
Fax Number	:	321-255-5552

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	03/19/2025

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