Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | G4655 | TX |
NPI | 1003819798 |
---|---|
Provider Name | Dr. Thomas Joseph Miller |
First Address | Arlington, TX 76015-3600 |
Second Address | Arlington, TX 76015-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 06/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C19391 | (02) | TX |