Provider Demographics
NPI:1417392903
Name:MINER, JASON ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALLEN
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 1:20 GREENMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3138
Mailing Address - Country:US
Mailing Address - Phone:405-314-2368
Mailing Address - Fax:
Practice Address - Street 1:4881 SUGAR MAPLE DR
Practice Address - Street 2:
Practice Address - City:WRIGHT PATTERSON AFB
Practice Address - State:OH
Practice Address - Zip Code:45433-5529
Practice Address - Country:US
Practice Address - Phone:937-257-0837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31131208600000X, 171000000X, 2086S0102X, 2086S0127X
TXS7920208600000X, 171000000X, 2086S0102X, 2086S0127X
390200000X
OH35.1345262086S0127X, 208600000X, 171000000X
OH34.1345262086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No171000000XOther Service ProvidersMilitary Health Care Provider
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care