Provider Demographics
NPI:1477331973
Name:MINTER, JACOB LEE
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:LEE
Last Name:MINTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6223 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-4807
Mailing Address - Country:US
Mailing Address - Phone:713-689-9099
Mailing Address - Fax:
Practice Address - Street 1:6223 SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-4807
Practice Address - Country:US
Practice Address - Phone:713-689-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program