Provider Demographics
NPI:1467454603
Name:MINER, ADAM SETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:SETH
Last Name:MINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 796534
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75379-6534
Mailing Address - Country:US
Mailing Address - Phone:972-234-6868
Mailing Address - Fax:972-238-1235
Practice Address - Street 1:1120 W CAMPBELL RD
Practice Address - Street 2:STE 111
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2976
Practice Address - Country:US
Practice Address - Phone:972-234-6868
Practice Address - Fax:972-238-1235
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612487OtherAETNA
TX2967769003OtherCIGNA
TX86690GOtherBLLUE CROSS/ BLUE SHIELD
TX115333001Medicaid
TX81780KMedicare ID - Type Unspecified
TX115333001Medicaid