Individual
DR. DAVID P MINICHAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1234 FRANKLIN RD SW, ROANOKE, VA 24016-4606
(540) 345-1561
(540) 345-2112
Mailing address
1234 FRANKLIN RD SW, ROANOKE, VA 24016-4606
(540) 345-1561
(540) 345-2112
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101012581
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007311150
—
VA
Enumeration date
08/19/2005
Last updated
09/04/2009
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