Individual
CHARLES ALAN MINER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
801 7TH AVE, FORT WORTH, TX 76104-2733
(682) 885-3199
(682) 885-7499
Mailing address
PO BOX 99213, FORT WORTH, TX 76199-0213
(682) 885-1855
(682) 885-7347
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
0001190931
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
739985
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201533101
—
TX
01
—
8133UU
BCBS
TX
Enumeration date
08/01/2006
Last updated
08/06/2010
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