Provider Demographics
NPI:1598780637
Name:MILLER, SAMUEL C (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:C
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 1:3920 W WHEATLAND RD STE 152
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3404
Mailing Address - Country:US
Mailing Address - Phone:214-467-0432
Mailing Address - Fax:214-467-0635
Practice Address - Street 1:3920 W WHEATLAND RD STE 152
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3404
Practice Address - Country:US
Practice Address - Phone:214-467-0432
Practice Address - Fax:214-467-0635
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142071301Medicaid
TX142071304Medicaid
TXD66992Medicare UPIN
TXTXB100086Medicare PIN
TX8401M4Medicare PIN