Organization
NORTH COUNTRY PHYSICIANS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER AUGUST MINAERT JR. MD (OWNER/PRESIDENT)
(315) 782-1990
Entity
Organization
Contact information
Practice address
21017 NYS RT 12F, WATERTOWN, NY 13601-1078
(315) 782-1990
(315) 782-0347
Mailing address
21017 NYS RT 12F, WATERTOWN, NY 13601-1078
(315) 782-1990
(315) 782-0347
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01909604
—
NY
Enumeration date
09/28/2006
Last updated
08/22/2020
Update your record
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