Provider Demographics
NPI:1750713145
Name:MINOT, MARK MORTON (MD, PHD, MBA, MSEE)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:MORTON
Last Name:MINOT
Suffix:
Gender:M
Credentials:MD, PHD, MBA, MSEE
Other - Prefix:
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Mailing Address - Street 1:78120 WILDCAT DR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-1140
Mailing Address - Country:US
Mailing Address - Phone:760-340-2682
Mailing Address - Fax:760-773-9695
Practice Address - Street 1:78120 WILDCAT DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-1140
Practice Address - Country:US
Practice Address - Phone:760-340-2682
Practice Address - Fax:760-773-9695
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA139525207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine