Provider Demographics
NPI:1518950419
Name:MINCK, RORY N (MD)
Entity Type:Individual
Prefix:
First Name:RORY
Middle Name:N
Last Name:MINCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 E US HIGHWAY 83
Mailing Address - Street 2:STE C
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6613
Mailing Address - Country:US
Mailing Address - Phone:956-969-8933
Mailing Address - Fax:956-969-8903
Practice Address - Street 1:1600 E US HIGHWAY 83
Practice Address - Street 2:STE C
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6613
Practice Address - Country:US
Practice Address - Phone:956-969-8903
Practice Address - Fax:956-969-8903
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK4157207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D37320Medicare UPIN
TX0085CBMedicare ID - Type Unspecified