Provider Demographics
NPI:1073584421
Name:STEPHEN MILLER MD PA
Entity Type:Organization
Organization Name:STEPHEN MILLER MD PA
Other - Org Name:DERMATOLOGY SAN ANTONIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-615-7171
Mailing Address - Street 1:16110 VIA SHAVANO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2380
Mailing Address - Country:US
Mailing Address - Phone:210-615-7171
Mailing Address - Fax:210-615-6793
Practice Address - Street 1:16110 VIA SHAVANO
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2380
Practice Address - Country:US
Practice Address - Phone:210-615-7171
Practice Address - Fax:210-615-6793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7586207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00024699OtherRR MEDICARE PTAN
TX1073584421OtherNPI
TXDG9652OtherRR MEDICARE PTAN GROUP
TXJ7586OtherSTATE LICENSE
TX8X5050OtherBCBS
TXDG9652OtherRR MEDICARE PTAN GROUP
TX1073584421OtherNPI