Provider Demographics
NPI:1760454060
Name:MILLER, STEPHEN (MD PA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8431 FREDERICKSBURG RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3364
Mailing Address - Country:US
Mailing Address - Phone:210-615-7171
Mailing Address - Fax:210-615-6793
Practice Address - Street 1:8431 FREDERICKSBURG RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3364
Practice Address - Country:US
Practice Address - Phone:210-615-7171
Practice Address - Fax:210-615-6793
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7586207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1073584421OtherNPI-GROUP
TXJ7586OtherLICENSE
TX1760454060OtherNPI
TX8X5050OtherBCBS OF TEXAS
TXP00024699OtherRAILROAD MEDICARE ID#
TX162478501Medicaid
TXDG9652OtherRR MEDICARE PTAN GROUP
TX8X5050OtherBCBS OF TEXAS
TX162478501Medicaid
TX8X5050OtherBCBS OF TEXAS
TXJ7586OtherLICENSE