Provider Demographics
NPI:1275790008
Name:MILLER, ANTONIO CRAIG JR
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:CRAIG
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ANTONIO
Other - Middle Name:CRAIG
Other - Last Name:MILLER
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:RMT,CMLD, CDT
Mailing Address - Street 1:1311 CHARDONNAY XING
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641
Mailing Address - Country:US
Mailing Address - Phone:512-796-6605
Mailing Address - Fax:512-535-2075
Practice Address - Street 1:3913 MEDICAL PKWY
Practice Address - Street 2:101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-4029
Practice Address - Country:US
Practice Address - Phone:512-797-3004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT027716174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX753208646OtherEIN