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General NPI Number Information
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NPI Number | 1376655829
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Entity Type | Individual
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Provider Name | FREDERICK GERALD MINER PA-C.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | GAMEDAY MENS HEALTH - SAN MARCOS 1340 WONDER WORLD DR, SUITE 104
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City | SAN MARCOS
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State | TX
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Zip | 78666
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Country | US
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Telephone | 737-331-0301
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Fax | 737-932-6224
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Provider Business Mailing Address
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Address Line | 1035 116TH AVE NE
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City | BELLEVUE
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State | WA
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Zip | 98004-4604
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Country | US
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Telephone | 425-688-5000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA10005213
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License Number State | WA
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