Provider Demographics
NPI:1053761551
Name:MINER, ALISHA RENEE (DO)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:RENEE
Last Name:MINER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:RENEE
Other - Last Name:MURROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1200 E PECAN ST
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-6141
Mailing Address - Country:US
Mailing Address - Phone:580-379-5000
Mailing Address - Fax:580-379-5509
Practice Address - Street 1:1200 E PECAN ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-6192
Practice Address - Country:US
Practice Address - Phone:580-379-5000
Practice Address - Fax:580-379-5509
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6222207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200724010AMedicaid