Provider Demographics
NPI:1073599205
Name:MILLER, WILFRED D (DO)
Entity Type:Individual
Prefix:
First Name:WILFRED
Middle Name:D
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 E US HIGHWAY 287
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-4105
Mailing Address - Country:US
Mailing Address - Phone:972-346-8115
Mailing Address - Fax:888-593-2028
Practice Address - Street 1:4031 E US HIGHWAY 287
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-4105
Practice Address - Country:US
Practice Address - Phone:972-346-8115
Practice Address - Fax:888-593-2028
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3915207Q00000X
AZ4334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E43698Medicare UPIN
E43698Medicare UPIN
AZ993081Medicaid