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Individual

MARK W MINOR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3021 W EAU GALLIE BLVD STE 102, MELBOURNE, FL 32934-7005
(321) 757-5550
(321) 255-5552
Mailing address
3021 W EAU GALLIE BLVD STE 102, MELBOURNE, FL 32934-7005
(321) 757-5550
(321) 255-5552

Taxonomy

Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
ME0045859
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1762243003
CIGNA
FL
01
26075
BCBS
FL
01
4038851
AETNA
FL
Enumeration date
06/17/2005
Last updated
03/19/2025
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