Provider Demographics
NPI:1043282981
Name:MINTON, GORDON H (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:H
Last Name:MINTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 OAK TREE CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932
Mailing Address - Country:US
Mailing Address - Phone:817-528-6169
Mailing Address - Fax:
Practice Address - Street 1:4815 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2705
Practice Address - Country:US
Practice Address - Phone:915-215-5666
Practice Address - Fax:915-215-5047
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-05
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM93-336207L00000X
ARE-6274207L00000X
TXH8262207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165665401Medicaid
NMNMAAA1223OtherMEDICARE PTAN
UT1043282981Medicaid
NM00006486Medicaid
AZ184474Medicaid
CO91933366Medicaid
TX8C0035Medicare ID - Type Unspecified
NMNMAAA1223OtherMEDICARE PTAN