Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 32796 | TX |
N | 204E00000X | Oral & Maxillofacial Surgeon | ME127863 | FL |
NPI | 1083680367 |
---|---|
Provider Name | Dr. Mark Allen Miller |
First Address | San Antonio, TX 78229-1397 |
Second Address | San Antonio, TX 78229-3923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 07/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3722233 | (05) | TX |