Provider Demographics
NPI:1255311569
Name:MILLER, EARL L JR (MD)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:L
Last Name:MILLER
Suffix:JR
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:PO BOX 200993
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-0993
Mailing Address - Country:US
Mailing Address - Phone:281-784-1111
Mailing Address - Fax:281-784-1111
Practice Address - Street 1:4000 SPENCER HWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1202
Practice Address - Country:US
Practice Address - Phone:713-359-2000
Practice Address - Fax:713-359-1004
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4570207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154810901Medicaid
TX1255311569OtherTRICARE SOUTH
TX154810902Medicaid
TX8G1507OtherBCBSTX PROV NO
TX1255311569OtherTRICARE SOUTH
TX930124660Medicare PIN
TX8L6507Medicare PIN
TX8A1943Medicare PIN