Provider Demographics
NPI:1538638143
Name:MILLER, DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:
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:THOMAS MOORE CLINIC
Mailing Address - Street 2:2245 761ST TANK BATTALION AVENUE
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:254-285-6230
Mailing Address - Fax:
Practice Address - Street 1:THOMAS MOORE CLINIC
Practice Address - Street 2:2245 761ST TANK BATTALION AVENUE
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-285-6230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE32424208D00000X
NEPEND208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice