Individual
MR. SAMUEL ANTHONY MINAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1201 W GRANDE BLVD, TYLER, TX 75703-6124
(903) 597-4644
(903) 266-9449
Mailing address
4539 CASCADES SHORELINE DR, TYLER, TX 75709-8902
(773) 590-9184
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
036155679
IL
207W00000X
Ophthalmology Physician
Primary
V9664
TX
207WX0107X
Retina Specialist (Ophthalmology) Physician
036.155679
IL
207WX0107X
Retina Specialist (Ophthalmology) Physician
V9664
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036155679
—
IL
Enumeration date
07/02/2021
Last updated
10/01/2025
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