Provider Demographics
NPI:1326117623
Name:MILLER, DAVID J (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 HEALTHPLEX PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-9801
Mailing Address - Country:US
Mailing Address - Phone:405-515-2222
Mailing Address - Fax:405-515-2288
Practice Address - Street 1:3500 HEALTHPLEX PKWY STE 200
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-9801
Practice Address - Country:US
Practice Address - Phone:405-515-2288
Practice Address - Fax:405-307-5715
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3039208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK300522262OtherMEDICARE GROUP PIN
OK100136920AMedicaid
OK100136920AMedicaid
OK249803101Medicare PIN