Provider Demographics
NPI:1053376715
Name:MINTER, MIKEANNE (MD)
Entity type:Individual
Prefix:DR
First Name:MIKEANNE
Middle Name:
Last Name:MINTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N COLUMBIA RIVER HWY STE 6
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-1201
Mailing Address - Country:US
Mailing Address - Phone:503-397-0471
Mailing Address - Fax:
Practice Address - Street 1:500 N COLUMBIA RIVER HWY
Practice Address - Street 2:STE 6
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-1299
Practice Address - Country:US
Practice Address - Phone:503-397-0471
Practice Address - Fax:503-366-5519
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23889207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227042Medicaid
ORH84765Medicare UPIN
OR227042Medicaid