Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | Q4638 | TX |
NPI | 1154603512 |
---|---|
Provider Name | Dr. Kyle Scott Miller |
First Address | Austin, TX 78723-3079 |
Second Address | Austin, TX 78723-3079 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2011 |
Last Update Date | 25/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
347847103 | (05) | TX |
Q4638 | TEXAS MEDICAL LICENSE (01) | TX |