Provider Demographics
NPI:1669477303
Name:MINTON, MORRIS SHEPPARD (M,D,)
Entity Type:Individual
Prefix:DR
First Name:MORRIS
Middle Name:SHEPPARD
Last Name:MINTON
Suffix:
Gender:M
Credentials:M,D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 RICHARDSON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-3265
Mailing Address - Country:US
Mailing Address - Phone:704-362-5034
Mailing Address - Fax:
Practice Address - Street 1:315 YADKIN ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3441
Practice Address - Country:US
Practice Address - Phone:704-982-4480
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19072207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCB50673Medicare UPIN
NC2279880BMedicare ID - Type UnspecifiedMEDICARE PROVIDER #