Provider Demographics
NPI:1003801234
Name:MINER, JR., PHILIP BARTON (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:BARTON
Last Name:MINER, JR.
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 N LINCOLN BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-3252
Mailing Address - Country:US
Mailing Address - Phone:405-271-4644
Mailing Address - Fax:405-271-3296
Practice Address - Street 1:1000 N LINCOLN BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-3252
Practice Address - Country:US
Practice Address - Phone:405-271-4644
Practice Address - Fax:405-271-3296
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19647207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD88703Medicare UPIN