Provider Demographics
NPI:1881652980
Name:MINER, JOSEPH K (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:K
Last Name:MINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:151 S UNIVERSITY AVE
Mailing Address - Street 2:SUITE 2800
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-4427
Mailing Address - Country:US
Mailing Address - Phone:801-851-7011
Mailing Address - Fax:801-851-7536
Practice Address - Street 1:151 S UNIVERSITY AVE
Practice Address - Street 2:SUITE 2800
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-4427
Practice Address - Country:US
Practice Address - Phone:801-851-7011
Practice Address - Fax:801-851-7536
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT161096-12052083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQM0000039389OtherALTIUS
UT103003506102OtherSELECT HEALTH PROVIDER
UT7565Medicaid
UT876112298013Medicaid
UT05664Medicaid
UT55102OtherPEHP
UT73-00012OtherUNITED HEALTH CARE
UTPR00489Medicaid
UT55102OtherPEHP
UTX12342Medicare UPIN
UT7565Medicaid