Provider Demographics
NPI:1700806882
Name:MINER, DAVID WESTON (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WESTON
Last Name:MINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:829 N CENTER AVE
Mailing Address - Street 2:SUITE 298
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1595
Mailing Address - Country:US
Mailing Address - Phone:989-731-7708
Mailing Address - Fax:989-731-7929
Practice Address - Street 1:829 N CENTER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1595
Practice Address - Country:US
Practice Address - Phone:989-731-2105
Practice Address - Fax:989-731-2440
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301068404207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1606900231OtherBLUECROSS BLUE SHIELD
MI3491388Medicaid
MI160041818Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MI1606900231OtherBLUECROSS BLUE SHIELD
MI0M68860Medicare ID - Type Unspecified
MIG34105Medicare UPIN