Provider Demographics
NPI:1073568812
Name:MINCE, DANIEL MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MARTIN
Last Name:MINCE
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 1:415 MEDICAL CENTER DR SW
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3421
Mailing Address - Country:US
Mailing Address - Phone:256-997-2820
Mailing Address - Fax:256-997-2890
Practice Address - Street 1:415 MEDICAL CENTER DR SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3421
Practice Address - Country:US
Practice Address - Phone:256-997-2820
Practice Address - Fax:256-997-2890
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00010888207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051534799Medicaid
AL515-33800OtherBCBS
AL051533800Medicaid
AL515-34799OtherBCBS
AL051533800MINMedicare PIN
AL051534799Medicare PIN
ALC73769Medicare UPIN
ALP00354482Medicare PIN