Provider Demographics
NPI:1790882108
Name:MILLER, BRIAN TERRY (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:TERRY
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 268945
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8945
Mailing Address - Country:US
Mailing Address - Phone:512-388-1861
Mailing Address - Fax:512-388-0373
Practice Address - Street 1:2000 N MAYS ST STE 109
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2166
Practice Address - Country:US
Practice Address - Phone:254-690-2800
Practice Address - Fax:254-690-5401
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4284207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0980013-03Medicaid
TX0980013-04Medicaid
TX8584N1Medicare PIN
TX8585N0Medicare PIN
TX0980013-03Medicaid