Provider Demographics
NPI:1275880163
Name:MILLER, LEZLIE (PA)
Entity Type:Individual
Prefix:
First Name:LEZLIE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3032 E HEBRON PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4465
Mailing Address - Country:US
Mailing Address - Phone:972-865-2880
Mailing Address - Fax:970-306-2564
Practice Address - Street 1:3032 E HEBRON PKWY STE 101
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4465
Practice Address - Country:US
Practice Address - Phone:972-865-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01301207Q00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine