Provider Demographics
NPI:1144386012
Name:MINO, THOMAS DWIGHT II (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DWIGHT
Last Name:MINO
Suffix:II
Gender:M
Credentials:DO
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Mailing Address - Street 1:2480 W 26TH AVE
Mailing Address - Street 2:SUITE 200B EPN
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-5309
Mailing Address - Country:US
Mailing Address - Phone:303-467-4162
Mailing Address - Fax:303-467-4156
Practice Address - Street 1:8350 WCR 13 (COLORADO BLVD)
Practice Address - Street 2:SUITE 160
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504
Practice Address - Country:US
Practice Address - Phone:303-689-5160
Practice Address - Fax:303-689-5175
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2008-03-13
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Provider Licenses
StateLicense IDTaxonomies
CO32805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01328053Medicaid
COC811331Medicare PIN
COC526518Medicare PIN
CO01328053Medicaid