Provider Demographics
NPI:1629027289
Name:MINKES, MARK S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:MINKES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11480 BROOKSHIRE AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5010
Mailing Address - Country:US
Mailing Address - Phone:562-904-1651
Mailing Address - Fax:562-904-1656
Practice Address - Street 1:11480 BROOKSHIRE AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5010
Practice Address - Country:US
Practice Address - Phone:562-904-1651
Practice Address - Fax:562-904-1656
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2008-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG38259208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0080690Medicaid
CAGR0080690OtherMEDI-CAL
CA990004307OtherPALMETTO RAILROAD MEDICARE
CA0004024011OtherAETNA
CAZZZ54573ZOtherBLUE SHIELD
CAGR0080690OtherMEDI-CAL