Provider Demographics
NPI:1518988195
Name:MILLER, JANICE A (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4115
Mailing Address - Country:US
Mailing Address - Phone:817-774-5008
Mailing Address - Fax:817-774-5034
Practice Address - Street 1:3517 S W WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:JOSHUA
Practice Address - State:TX
Practice Address - Zip Code:76058-9659
Practice Address - Country:US
Practice Address - Phone:817-447-1151
Practice Address - Fax:817-529-8927
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113648305Medicaid
TX0081QROtherBCBS
TXC36320Medicare UPIN
TX394423ZKEMMedicare PIN
TX613162Medicare PIN