Provider Demographics
NPI:1417903329
Name:MILLER, JUDY ANGELA (DO)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ANGELA
Last Name:MILLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2917 E 211TH ST S
Mailing Address - Street 2:
Mailing Address - City:MOUNDS
Mailing Address - State:OK
Mailing Address - Zip Code:74047-5070
Mailing Address - Country:US
Mailing Address - Phone:918-694-1474
Mailing Address - Fax:918-366-1028
Practice Address - Street 1:801 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5630
Practice Address - Country:US
Practice Address - Phone:505-609-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDO2022-0067207R00000X
OK4215207R00000X
NYDO2022-0067207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200061470AMedicaid
OK242708006Medicare PIN
OK200061470AMedicaid
OKP00378255Medicare PIN