Provider Demographics
NPI:1821032236
Name:MILLER, PATRICIA A (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TYLERTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:39667-2020
Mailing Address - Country:US
Mailing Address - Phone:601-876-5835
Mailing Address - Fax:601-876-0653
Practice Address - Street 1:200 HOSPITAL DR.
Practice Address - Street 2:
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667-2020
Practice Address - Country:US
Practice Address - Phone:601-876-5835
Practice Address - Fax:601-876-0653
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126491Medicaid
F92034Medicare UPIN
MS080005058Medicare PIN