Healthcare Provider Details

I. General information

NPI: 1316475742
Provider Name (Legal Business Name): ROBERT JACK HENRY MILLER MD, FRCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 05/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 TUSCANY RAVINE CLOSE NW
CALGARY AB
T3L 2Y6
CA

IV. Provider business mailing address

162 TUSCANY RAVINE CLOSE NW
CALGARY AB
T3L 2Y6
CA

V. Phone/Fax

Practice location:
  • Phone: 403-606-5553
  • Fax: 403-944-2757
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number148528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: