Provider Demographics
NPI:1750634218
Name:MINTER, DANIEL MARK (PA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MARK
Last Name:MINTER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:2115 NE WYATT CT STE 201
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7680
Mailing Address - Country:US
Mailing Address - Phone:541-585-2400
Mailing Address - Fax:
Practice Address - Street 1:2115 NE WYATT CT STE 201
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7680
Practice Address - Country:US
Practice Address - Phone:541-585-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA178695363A00000X
NY015987363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant