Provider Demographics
NPI:1659558286
Name:MINA, MA LOURDES BLAS (MD)
Entity Type:Individual
Prefix:
First Name:MA LOURDES
Middle Name:BLAS
Last Name:MINA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:380 HOSPITAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-8001
Mailing Address - Country:US
Mailing Address - Phone:478-743-4646
Mailing Address - Fax:478-742-5549
Practice Address - Street 1:380 HOSPITAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-8001
Practice Address - Country:US
Practice Address - Phone:478-743-4646
Practice Address - Fax:478-742-5549
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2015-02-25
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Provider Licenses
StateLicense IDTaxonomies
GA001708207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology