Provider Demographics
NPI:1497753941
Name:MILLER, LAURA S (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:S
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:K
Other - Last Name:SHERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:929 ELECTRA
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-4215
Mailing Address - Country:US
Mailing Address - Phone:917-968-1586
Mailing Address - Fax:
Practice Address - Street 1:929 ELECTRA
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-4215
Practice Address - Country:US
Practice Address - Phone:917-968-1586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207271207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01850119Medicaid
NY01850119Medicaid
NY23N291Medicare ID - Type Unspecified