Healthcare Provider Details

I. General information

NPI: 1043368715
Provider Name (Legal Business Name): ROBERT L MILLER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N MAIN ST
HARRISON AR
72601-2994
US

IV. Provider business mailing address

PO BOX 1812
HARRISON AR
72602-1812
US

V. Phone/Fax

Practice location:
  • Phone: 870-414-4026
  • Fax:
Mailing address:
  • Phone: 870-414-4026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMC-1562
License Number StateAR

VIII. Authorized Official

Name: DR. ROBERT L MILLER JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 870-414-4026