Provider Demographics
NPI:1942206479
Name:MINGUS, DANNY L (PA-C)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:L
Last Name:MINGUS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 SOUTH THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:WA
Mailing Address - Zip Code:99328
Mailing Address - Country:US
Mailing Address - Phone:509-382-3200
Mailing Address - Fax:509-382-2748
Practice Address - Street 1:1012 SOUTH THIRD STREET
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:WA
Practice Address - Zip Code:99328
Practice Address - Country:US
Practice Address - Phone:509-382-3200
Practice Address - Fax:509-382-2748
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61286722363A00000X
COPA.0004609363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2208894Medicaid
CO504498ZS0NOtherMEDICARE B PTAN FOR NORTH FORK MEDICAL CLINIC
CO517692YYS0OtherMEDICARE B PTAN FOR MOUNTAIN PEAKS URGENT CARE