Healthcare Provider Details

I. General information

NPI: 1265414221
Provider Name (Legal Business Name): ROBERT LAWRENCE MILLER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N WILLOW 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: 870-365-2026
  • Fax:
Mailing address:
  • Phone: 870-365-2026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberN-6327
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberR7C70
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: