Provider Demographics
NPI:1710397773
Name:JASON C MILLER DPM PA
Entity Type:Organization
Organization Name:JASON C MILLER DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-348-2166
Mailing Address - Street 1:350 KINGWOOD MEDICAL DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-6405
Mailing Address - Country:US
Mailing Address - Phone:281-348-2166
Mailing Address - Fax:281-358-2153
Practice Address - Street 1:350 KINGWOOD MEDICAL DR
Practice Address - Street 2:SUITE 150
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-6405
Practice Address - Country:US
Practice Address - Phone:281-348-2166
Practice Address - Fax:281-358-2153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2087213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2087OtherSTATE LICENSE NUMBER