Provider Demographics
NPI:1710942149
Name:MINER, THOMAS (PA-C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MINER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:
Mailing Address - City:MILLER
Mailing Address - State:SD
Mailing Address - Zip Code:57362-0287
Mailing Address - Country:US
Mailing Address - Phone:605-853-2447
Mailing Address - Fax:605-853-3885
Practice Address - Street 1:300 W 5TH ST
Practice Address - Street 2:
Practice Address - City:MILLER
Practice Address - State:SD
Practice Address - Zip Code:57362-1238
Practice Address - Country:US
Practice Address - Phone:605-853-2447
Practice Address - Fax:605-853-3885
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0365363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical