Provider Demographics
NPI:1427004142
Name:MINKOFF, IRENE MONICA (MD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:MONICA
Last Name:MINKOFF
Suffix:
Gender:F
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:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-0062
Mailing Address - Country:US
Mailing Address - Phone:970-244-7500
Mailing Address - Fax:970-255-7262
Practice Address - Street 1:750 WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6132
Practice Address - Country:US
Practice Address - Phone:970-244-7500
Practice Address - Fax:970-255-7262
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39646174400000X
CODR-39646207RH0003X
WAMD00038292207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45751544Medicaid
COC810833Medicare PIN
CO45751544Medicaid