Provider Demographics
NPI:1700220027
Name:MINIX, JOSHUA TIMOTHY (DO)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:TIMOTHY
Last Name:MINIX
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-0406
Mailing Address - Country:US
Mailing Address - Phone:606-889-6370
Mailing Address - Fax:606-263-5654
Practice Address - Street 1:5000 KY ROUTE 321 STE 3141
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9113
Practice Address - Country:US
Practice Address - Phone:606-889-6370
Practice Address - Fax:606-263-5654
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3277207R00000X
390200000X
KY03834207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100324600Medicaid