Provider Demographics
NPI:1225035868
Name:MINER, JAMES A (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:MINER
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 1:1613 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1849
Mailing Address - Country:US
Mailing Address - Phone:407-894-4474
Mailing Address - Fax:407-894-7136
Practice Address - Street 1:1613 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1849
Practice Address - Country:US
Practice Address - Phone:407-894-4474
Practice Address - Fax:407-894-7136
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0022154207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1985725OtherCIGNA
FL269859500OtherMEDICAID GRP
FL77940OtherBCBS GRP
FLME22154OtherSTATE MEDICAL LICENSE
FL77940OtherMEDICARE GRP
FL78165OtherBCBS
FLCF1412OtherMEDICARE RR GRP
FL78165OtherBCBS
FLCF1412OtherMEDICARE RR GRP