Provider Demographics
NPI:1760745459
Name:MARK MINSON PHD, PA
Entity Type:Organization
Organization Name:MARK MINSON PHD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:I
Authorized Official - Last Name:MINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-999-9890
Mailing Address - Street 1:4710 NW 2ND AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4879
Mailing Address - Country:US
Mailing Address - Phone:561-999-9890
Mailing Address - Fax:561-999-9454
Practice Address - Street 1:4710 NW 2ND AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4879
Practice Address - Country:US
Practice Address - Phone:561-999-9890
Practice Address - Fax:561-999-9454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3478261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health