Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 80997 | MA |
NPI | 1205894177 |
---|---|
Provider Name | Kimball Austin Miller |
First Address | Amarillo, TX 79119-6472 |
Second Address | Amarillo, TX 79119-6472 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 08/07/2007 |