Provider Demographics
NPI:1841721594
Name:MINZES, GWEN ANN (DO)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:ANN
Last Name:MINZES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GWEN
Other - Middle Name:
Other - Last Name:HESTWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 23321
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-3321
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:2403 ALLISON RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5923
Practice Address - Country:US
Practice Address - Phone:843-524-1078
Practice Address - Fax:843-524-1137
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC83031208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program