Provider Demographics
NPI:1952625725
Name:MILLER, FREDDIE L JR
Entity type:Individual
Prefix:MR
First Name:FREDDIE
Middle Name:L
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 1:1024 TRAILWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-5544
Mailing Address - Country:US
Mailing Address - Phone:214-243-3547
Mailing Address - Fax:972-230-6062
Practice Address - Street 1:1024 TRAILWOOD DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-5544
Practice Address - Country:US
Practice Address - Phone:214-243-3547
Practice Address - Fax:972-230-6062
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator