Provider Demographics
NPI:1356828305
Name:DR. PETERYNE D. MILLER, M.D. LLC
Entity Type:Organization
Organization Name:DR. PETERYNE D. MILLER, M.D. LLC
Other - Org Name:DR. PETERYNE D. MILLER, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MAANGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-863-2910
Mailing Address - Street 1:4870 S LEWIS AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-5153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4870 S LEWIS AVE STE 205
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-5153
Practice Address - Country:US
Practice Address - Phone:918-863-2910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200085110BMedicaid