Healthcare Provider Details

I. General information

NPI: 1235326893
Provider Name (Legal Business Name): PHILIP B MINER JR MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N LINCOLN BLVD STE 210
OKLAHOMA CITY OK
73104-3252
US

IV. Provider business mailing address

1000 N LINCOLN BLVD STE 210
OKLAHOMA CITY OK
73104-3252
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4644
  • Fax: 405-271-3296
Mailing address:
  • Phone: 405-271-4644
  • Fax: 405-271-3296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19647
License Number StateOK

VIII. Authorized Official

Name: MRS. SHERRY L WOLFENKOEHLER
Title or Position: BUS OFC MGR
Credential:
Phone: 405-691-4703