Provider Demographics
NPI:1740289081
Name:MINOR, LOUISE ANNE (PHD, MD)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:ANNE
Last Name:MINOR
Suffix:
Gender:F
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2634 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3223
Mailing Address - Country:US
Mailing Address - Phone:707-442-8911
Mailing Address - Fax:707-445-2023
Practice Address - Street 1:2634 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3223
Practice Address - Country:US
Practice Address - Phone:707-442-8911
Practice Address - Fax:707-445-2023
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG56405207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA180004274OtherRR MEDICARE
CA00G564050Medicaid
A53130Medicare UPIN
CA00G564050Medicaid