Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 15810 | TX |
NPI | 1053373365 |
---|---|
Provider Name | Dr. Robert James Miller JR. |
First Address | Fort Sam Houston, TX 78234-7529 |
Second Address | Fort Sam Houston, TX 78234-7529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 08/07/2007 |