Provider Demographics
NPI:1205140522
Name:MINKNER, RICHARD DUNCAN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DUNCAN
Last Name:MINKNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 SOQUEL AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062
Mailing Address - Country:US
Mailing Address - Phone:831-425-1279
Mailing Address - Fax:831-425-3500
Practice Address - Street 1:540 SOQUEL AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2353
Practice Address - Country:US
Practice Address - Phone:831-425-1279
Practice Address - Fax:831-425-3500
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA122267207Q00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program