MEDICARE: DR. JAMES GRANT MILLER JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	MD040893E	PA

General Provider Information

NPI Number	:	1902887383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES GRANT MILLER JR. M.D.

Provider Business Mailing Address
First Line	:	9910 MARIE MDW
Second Line	:
City	:	GARDEN RIDGE
State	:	TX
Zip	:	78266-2343
Country	:	US
Telephone Number	:	219-637-1194
Fax Number	:

Provider Business Practice Location Address
First Line	:	36000 DARNALL LOOP
Second Line	:	CRDAMC
City	:	FORT HOOD
State	:	TX
Zip	:	76544-5095
Country	:	US
Telephone Number	:	254-288-8945
Fax Number	:	254-288-8924

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	06/27/2012

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