Provider Demographics
NPI:1528044351
Name:MILLER, GREGORY STEWART (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:STEWART
Last Name:MILLER
Suffix:
Gender:M
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:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:6606 LBJ FWY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6524
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6600207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124717307OtherMEDICAID CSHCN
TX124717301Medicaid
TX124717306Medicaid
TX124717305Medicaid
TX86120YOtherBCBS
TX8EH603OtherBCBS TX
TX124717308OtherMEDICAID CSHCN
TX124717312Medicaid
G50557Medicare UPIN
TX124717306Medicaid
TX124717307OtherMEDICAID CSHCN
TX124717312Medicaid
TX124717305Medicaid
TX8L12010Medicare PIN