Provider Demographics
NPI:1407088560
Name:ED C MILLER MD PA
Entity Type:Organization
Organization Name:ED C MILLER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:C
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-368-1483
Mailing Address - Street 1:8226 DOUGLAS AVE
Mailing Address - Street 2:533
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5927
Mailing Address - Country:US
Mailing Address - Phone:214-368-1483
Mailing Address - Fax:214-369-4234
Practice Address - Street 1:8226 DOUGLAS AVE
Practice Address - Street 2:533
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5927
Practice Address - Country:US
Practice Address - Phone:214-368-1483
Practice Address - Fax:214-369-4234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC3148207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty