Provider Demographics
NPI:1962637769
Name:DOUGLAS L MINER MD PC
Entity Type:Organization
Organization Name:DOUGLAS L MINER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DOULAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-781-7072
Mailing Address - Street 1:3935 WILLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GREEN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-9867
Mailing Address - Country:US
Mailing Address - Phone:940-781-7072
Mailing Address - Fax:
Practice Address - Street 1:3935 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GREEN
Practice Address - State:UT
Practice Address - Zip Code:84050-9867
Practice Address - Country:US
Practice Address - Phone:940-781-7072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty