Provider Demographics
NPI:1023295664
Name:MINER, CALEB DAVID (PA-C)
Entity type:Individual
Prefix:MR
First Name:CALEB
Middle Name:DAVID
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:ONE VANTAGE WAY, SUITE B-240
Mailing Address - Street 2:MIDDLE TENNESSEE EMERGENCY PHYSICIANS, PC
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1562
Mailing Address - Country:US
Mailing Address - Phone:904-953-2000
Mailing Address - Fax:
Practice Address - Street 1:400 NORTH HIGHLAND AVE
Practice Address - Street 2:MIDDLE TENNESSEE MEDICAL CENTER
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130
Practice Address - Country:US
Practice Address - Phone:904-953-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104565363A00000X
TN1659363A00000X
CO2517363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL293100100Medicaid
FL293100100Medicaid