Provider Demographics
NPI:1881854776
Name:MILLER, MAISIE (MD)
Entity Type:Individual
Prefix:
First Name:MAISIE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
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:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:750 8TH AVE
Practice Address - Street 2:STE 600
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2515
Practice Address - Country:US
Practice Address - Phone:682-885-6726
Practice Address - Fax:682-885-6729
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4285208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics