Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 7304 | TX |
NPI | 1538361738 |
---|---|
Provider Name | James G Miller |
First Address | Tyler, TX 75710-2039 |
Second Address | Tyler, TX 75702-6159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7304 | MEDICAL LICENSE (01) | TX |