Provider Demographics
NPI:1578535696
Name:MINOR, DAVID FRANCIS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:FRANCIS
Last Name:MINOR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3069 TRENWEST DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3211
Mailing Address - Country:US
Mailing Address - Phone:336-922-1102
Mailing Address - Fax:336-922-5012
Practice Address - Street 1:3734 REYNOLDA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-2240
Practice Address - Country:US
Practice Address - Phone:336-922-1102
Practice Address - Fax:336-922-5012
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101184363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC152UWOtherBCBS
Q06132Medicare UPIN
NC152UWOtherBCBS