Healthcare Provider Details

I. General information

NPI: 1417392903
Provider Name (Legal Business Name): JASON ALLEN MINER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DR
WRIGHT PATTERSON AFB OH
45433-5529
US

IV. Provider business mailing address

20 GREENMOUNT BLVD
OAKWOOD OH
45419-3138
US

V. Phone/Fax

Practice location:
  • Phone: 937-257-0837
  • Fax:
Mailing address:
  • Phone: 405-314-2368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberS7920
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number35.134526
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number31131
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberS7920
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number35.134526
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number31131
License Number StateOK
# 8
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberS7920
License Number StateTX
# 9
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35.134526CTR
License Number StateOH
# 10
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number31131
License Number StateOK
# 11
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.134526
License Number StateOH
# 12
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number34.134526
License Number StateOH
# 13
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number31131
License Number StateOK
# 14
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberS7920
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: