Provider Demographics
NPI:1588676449
Name:MILLER, GREGORY JAMES (PA-C, MPAS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:JAMES
Last Name:MILLER
Suffix:
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 CORPORATE DRIVE OLYMPIA II BUSINESS
Mailing Address - Street 2:SUITE #804
Mailing Address - City:SELMA
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1258
Mailing Address - Country:US
Mailing Address - Phone:830-572-5738
Mailing Address - Fax:210-756-6189
Practice Address - Street 1:9330 CORPORATE DRIVE OLYMPIA II BUSINESS
Practice Address - Street 2:SUITE #804
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154-1258
Practice Address - Country:US
Practice Address - Phone:830-572-5738
Practice Address - Fax:210-756-6189
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246ZC0007X
COPA1055363A00000X, 363AM0700X
TXPA02238363AS0400X, 363AM0700X
WAPA10005152363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical