Provider Demographics
NPI:1174501548
Name:MILLER, LAURENCE HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:HOWARD
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 1:4313 W MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4023
Mailing Address - Country:US
Mailing Address - Phone:501-686-9406
Mailing Address - Fax:501-686-9127
Practice Address - Street 1:4313 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4023
Practice Address - Country:US
Practice Address - Phone:501-686-9406
Practice Address - Fax:501-686-9127
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE03062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B95193Medicare UPIN
AR5J630Medicare ID - Type Unspecified