Provider Demographics
NPI:1386643963
Name:MILLER, BARRY RAY (MA)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:RAY
Last Name:MILLER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3820 HIGHWAY 365
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-7543
Mailing Address - Country:US
Mailing Address - Phone:409-721-5150
Mailing Address - Fax:409-721-6102
Practice Address - Street 1:3820 HIGHWAY 365
Practice Address - Street 2:SUITE 200
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-7543
Practice Address - Country:US
Practice Address - Phone:409-721-5150
Practice Address - Fax:409-721-6102
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5674208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1141806-01Medicaid
TXE13735Medicare UPIN
TX1141806-01Medicaid