Provider Demographics
NPI:1245677343
Name:MILLER, JORDAN GEHDE (BS)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:GEHDE
Last Name:MILLER
Suffix:
Gender:F
Credentials:BS
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 592442
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-0172
Mailing Address - Country:US
Mailing Address - Phone:210-566-2333
Mailing Address - Fax:210-566-1330
Practice Address - Street 1:524 EXCHANGE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-2116
Practice Address - Country:US
Practice Address - Phone:210-566-2333
Practice Address - Fax:210-566-1330
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic