Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | H5007 | TX |
NPI | 1063493831 |
---|---|
Provider Name | James P Miller |
First Address | Fort Worth, TX 76199-0371 |
Second Address | Fort Worth, TX 76104-2710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 02/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
117648905 | (05) | TX |
117648906 | (05) | TX |
137345810 | (05) | TX |
140442852 | (05) | TX |
1750369203 | NPI GROUP NUMBER (01) | |
8A5664 | BCBSTX PIN (01) | TX |
C19385 | (02) |