Provider Demographics
NPI:1942368535
Name:MINOR, GERARD (PA-C)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:
Last Name:MINOR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5955 PONCE DE LEON BLVD.
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2423
Mailing Address - Country:US
Mailing Address - Phone:305-661-1515
Mailing Address - Fax:305-662-3723
Practice Address - Street 1:1150 N 35 AVE
Practice Address - Street 2:SUITE 545
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-967-9400
Practice Address - Fax:954-967-9551
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA09101834363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant