MEDICARE: ADAM S. MINER, MD, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	J2689	TX
2	207Q00000X	Family Medicine Physician	J2689	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245416619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADAM S. MINER, MD, PA

Provider Business Mailing Address
First Line	:	PO BOX 796534
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75379-6534
Country	:	US
Telephone Number	:	972-234-6868
Fax Number	:	972-238-1235

Provider Business Practice Location Address
First Line	:	1120 W CAMPBELL RD
Second Line	:	SUITE 111
City	:	RICHARDSON
State	:	TX
Zip	:	75080-2976
Country	:	US
Telephone Number	:	972-234-6868
Fax Number	:	972-238-1235

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	DR. ADAM S MINER
Credential	:	MD
Telephone Number	:	972-234-6868

Provider Enumeration Date	:	01/16/2008
Last Update Date	:	05/15/2009

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Directions to “ADAM S. MINER, MD, PA ” Practice Location

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