Provider Demographics
NPI:1225430028
Name:MINA, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MINA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2115 CRYSTAL GROVE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-6875
Mailing Address - Country:US
Mailing Address - Phone:863-688-2334
Mailing Address - Fax:863-577-0301
Practice Address - Street 1:1305 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4542
Practice Address - Country:US
Practice Address - Phone:863-688-2334
Practice Address - Fax:863-577-0301
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2024-01-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME1450612085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology