Individual
EDWARD GUSTAVO MINTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 PALMETTO PARK BLVD, LEXINGTON, SC 29072
(803) 806-0080
(803) 356-0668
Mailing address
PO BOX 60371, CHARLOTTE, NC 28260-0371
(803) 806-0080
(803) 356-0668
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
16570
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165706
—
SC
Enumeration date
04/06/2006
Last updated
08/24/2021
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