Provider Demographics
NPI:1376560995
Name:MILLER, BILLY (MD)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:
Last Name:MILLER
Suffix:
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 1:2402 ADDISON RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1810
Mailing Address - Country:US
Mailing Address - Phone:713-927-3020
Mailing Address - Fax:
Practice Address - Street 1:1925 E TC JESTER BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1551
Practice Address - Country:US
Practice Address - Phone:713-927-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5467207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166100101Medicaid
TX166100104Medicaid
TX166100102Medicaid
TX166100103Medicaid
TX8G0760Medicare PIN
TX8B9397Medicare PIN
TX8B9378Medicare PIN
TX166100104Medicaid
I07889Medicare UPIN