Provider Demographics
NPI:1417045592
Name:MILLER, BRUCE (DPM)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6021 FAIRMONT PKWY
Mailing Address - Street 2:STE 130
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-4022
Mailing Address - Country:US
Mailing Address - Phone:281-991-0600
Mailing Address - Fax:281-991-0638
Practice Address - Street 1:6021 FAIRMONT PKWY
Practice Address - Street 2:STE 130
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-4022
Practice Address - Country:US
Practice Address - Phone:281-991-0600
Practice Address - Fax:281-991-0638
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX0648213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0648OtherLICENSE
TXK0036113OtherDPS
TXK0036113OtherDPS
TXEP60Medicare ID - Type Unspecified
TXAM8488137OtherDEA