Provider Demographics
NPI:1780647479
Name:MILLER, JAMES LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:LEE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:200 S RHODES
Mailing Address - Street 2:#C
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301
Mailing Address - Country:US
Mailing Address - Phone:870-735-0835
Mailing Address - Fax:870-732-3970
Practice Address - Street 1:200 S RHODES
Practice Address - Street 2:#C
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301
Practice Address - Country:US
Practice Address - Phone:870-735-0835
Practice Address - Fax:870-732-3970
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4781208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR53666OtherBC
AR080030219OtherRR MCR
AR101939001Medicaid
D17004Medicare UPIN
AR101939001Medicaid