Basic Information
| Provider Information | |||||||||
| NPI: | 1417392903 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MINER | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 GREENMOUNT BLVD | ||||||||
| Address2: | |||||||||
| City: | OAKWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454193138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053142368 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4881 SUGAR MAPLE DR | ||||||||
| Address2: | |||||||||
| City: | WRIGHT PATTERSON AFB | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454335529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372570837 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2013 | ||||||||
| LastUpdateDate: | 08/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 31131 | OK | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | S7920 | TX | N | Allopathic & Osteopathic Physicians | Surgery | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2086S0127X | 35.134526 | OH | Y | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 171000000X | 31131 | OK | N | Other Service Providers | Military Health Care Provider | 171000000X | S7920 | TX | N | Other Service Providers | Military Health Care Provider | 208600000X | 35.134526 | OH | N | Allopathic & Osteopathic Physicians | Surgery | 171000000X | 35.134526 | OH | N | Other Service Providers | Military Health Care Provider | 2086S0102X | 34.134526 | OH | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | 31131 | OK | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | S7920 | TX | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0127X | 31131 | OK | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 2086S0127X | S7920 | TX | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery |
No ID Information.