Provider Demographics
NPI:1043368715
Name:ROBERT L MILLER MD PA
Entity Type:Organization
Organization Name:ROBERT L MILLER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:870-414-4026
Mailing Address - Street 1:PO BOX 1812
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602-1812
Mailing Address - Country:US
Mailing Address - Phone:870-414-4026
Mailing Address - Fax:
Practice Address - Street 1:620 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2994
Practice Address - Country:US
Practice Address - Phone:870-414-4026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-1562207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR109945001Medicaid
AR132933002Medicaid
53682OtherBLUECROSSBLUESHIELD
138900000OtherQUALCHOICE
01976OtherHEALTHSOURCE
770063301OtherARKANSAS BREASTCARE
5F778OtherBLUECROSSBLUESHIELD
220002698OtherPALMETTO GBA
770063301OtherARKANSAS BREASTCARE
220002698OtherPALMETTO GBA