Provider Demographics
NPI:1245457902
Name:MILLER, BOBBY JOE JR
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:JOE
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 COUNTY ROAD 3133
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-4609
Mailing Address - Country:US
Mailing Address - Phone:940-399-8904
Mailing Address - Fax:
Practice Address - Street 1:4600 TAFT BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-4935
Practice Address - Country:US
Practice Address - Phone:940-691-1710
Practice Address - Fax:940-691-2193
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1146058174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist