Provider Demographics
NPI:1346205440
Name:MINARD, DAVID J (PA C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:MINARD
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 862851
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-2851
Mailing Address - Country:US
Mailing Address - Phone:954-847-4273
Mailing Address - Fax:954-847-4245
Practice Address - Street 1:2415 N ORANGE AVE STE 700
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5521
Practice Address - Country:US
Practice Address - Phone:407-303-2474
Practice Address - Fax:407-303-0680
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9101363363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292009300Medicaid
Q36279Medicare UPIN