Individual
IRA R. MINTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MO
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G29085
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G290850
BLUE SHIELD
CA
05
—
00G290850
—
CA
Enumeration date
08/03/2006
Last updated
01/31/2014
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