Provider Demographics
NPI:1043296494
Name:MINKIN, DARIN MARSHALL (DO)
Entity Type:Individual
Prefix:DR
First Name:DARIN
Middle Name:MARSHALL
Last Name:MINKIN
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:2355 DOUGHERTY FERRY RD
Mailing Address - Street 2:430
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-3325
Mailing Address - Country:US
Mailing Address - Phone:314-965-8410
Mailing Address - Fax:314-965-8756
Practice Address - Street 1:2355 DOUGHERTY FERRY RD
Practice Address - Street 2:430
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122
Practice Address - Country:US
Practice Address - Phone:314-965-8410
Practice Address - Fax:314-965-8756
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2000170421208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209057603Medicaid
MO916594191Medicare ID - Type Unspecified
MO209057603Medicaid