Provider Demographics
NPI:1386660496
Name:MINNIX, WILLIAM HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HENRY
Last Name:MINNIX
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 1:1615 PASADENA AVE S
Mailing Address - Street 2:SUITE 430
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4516
Mailing Address - Country:US
Mailing Address - Phone:727-397-0606
Mailing Address - Fax:727-397-6161
Practice Address - Street 1:1615 PASADENA AVE S
Practice Address - Street 2:SUITE 430
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4516
Practice Address - Country:US
Practice Address - Phone:727-397-0606
Practice Address - Fax:727-397-6161
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036772207P00000X, 207R00000X
FLME36772207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039785700Medicaid
FL039785700Medicaid
15574TMedicare PIN