Provider Demographics
NPI:1790722916
Name:MILLER, SCOTT D (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
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 1:4302 WOLFLIN AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-5959
Mailing Address - Country:US
Mailing Address - Phone:806-355-9866
Mailing Address - Fax:806-355-4004
Practice Address - Street 1:4302 WOLFLIN AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-5959
Practice Address - Country:US
Practice Address - Phone:806-355-9866
Practice Address - Fax:806-355-4004
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4591207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8H8491OtherBC/BS NUMBER
TXP00778494OtherRR MEDICARE
TX8L22736Medicare PIN
TX8H8491OtherBC/BS NUMBER