Provider Demographics
NPI:1235326893
Name:PHILIP B MINER JR MD INC
Entity Type:Organization
Organization Name:PHILIP B MINER JR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUS OFC MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOLFENKOEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-691-4703
Mailing Address - Street 1:1000 N LINCOLN BLVD STE 210
Mailing Address - Street 2:
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 STE 210
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19647207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKDE9317OtherMC RR