Provider Demographics
NPI:1508545146
Name:MILLER, BILLY JOE
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:JOE
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 SILVER CREEK RD LOT 21
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8315
Mailing Address - Country:US
Mailing Address - Phone:509-429-5027
Mailing Address - Fax:
Practice Address - Street 1:2960 SILVER CREEK RD LOT 21
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8315
Practice Address - Country:US
Practice Address - Phone:509-429-5027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZE85708402172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver