Provider Demographics
NPI:1164411021
Name:MILLER, JASON CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:CHRISTOPHER
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 1:25511 BUDDE RD STE 3701
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-4173
Mailing Address - Country:US
Mailing Address - Phone:281-348-2166
Mailing Address - Fax:281-358-2153
Practice Address - Street 1:1330 KINGWOOD DR STE 200
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3038
Practice Address - Country:US
Practice Address - Phone:281-348-2166
Practice Address - Fax:281-358-2153
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1555213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177385501Medicaid
TX177385501Medicaid
TXDE1381Medicare PIN
TX5541990001Medicare NSC
TXP00274104Medicare PIN
TX8F1314Medicare PIN
TX00609ZMedicare PIN
5541990001Medicare PIN