Provider Demographics
NPI:1568411999
Name:MILLER, LANCE J (DO)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:J
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 I 30
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6905
Mailing Address - Country:US
Mailing Address - Phone:469-800-2800
Mailing Address - Fax:469-800-2801
Practice Address - Street 1:1575 I 30
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6905
Practice Address - Country:US
Practice Address - Phone:469-800-2800
Practice Address - Fax:469-800-2801
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0966350-01Medicaid
TX080142187OtherRR MEDICARE
TX85481XOtherBCBS
TX0966350-01Medicaid
TX0966350-01Medicaid