Provider Demographics
NPI:1073627501
Name:MILLER, HARRY SHAWN (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:SHAWN
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 ROYAL COLONNADE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-3260
Mailing Address - Country:US
Mailing Address - Phone:817-275-5261
Mailing Address - Fax:817-548-8639
Practice Address - Street 1:2205 N TARRANT PKWY
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-2204
Practice Address - Country:US
Practice Address - Phone:817-328-3320
Practice Address - Fax:817-328-3320
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3616207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031446010Medicaid
TX8BT325OtherBCBS THRU SAEMA
TXG95988Medicare UPIN
TX8F9886Medicare PIN