Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 0425 | TX |
Y | 213ES0131X | Foot Surgery | 0425 | TX |
NPI | 1326073115 |
---|---|
Provider Name | Michael Jan Miller |
First Address | Mesquite, TX 75150-4157 |
Second Address | Mesquite, TX 75150-6903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 06/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0018779101 | (05) | TX |
T14828 | (02) | TX |