Provider Demographics
NPI:1265414221
Name:MILLER, ROBERT LAWRENCE JR
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LAWRENCE
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:PO BOX 1812
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602-1812
Mailing Address - Country:US
Mailing Address - Phone:870-365-2026
Mailing Address - Fax:
Practice Address - Street 1:620 N WILLOW ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2994
Practice Address - Country:US
Practice Address - Phone:870-365-2026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN-6327207ZP0102X
MOR7C70207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology