Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 19647 | OK |
NPI | 1003801234 |
---|---|
Provider Name | Dr. Philip Barton Miner, Jr. |
First Address | Oklahoma City, OK 73104-3252 |
Second Address | Oklahoma City, OK 73104-3252 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D88703 | (02) | OK |