Healthcare Provider Details

I. General information

NPI: 1417903329
Provider Name (Legal Business Name): JUDY ANGELA MILLER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGIE MILLER DO

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W MAPLE ST
FARMINGTON NM
87401-5630
US

IV. Provider business mailing address

2917 E 211TH ST S
MOUNDS OK
74047-5070
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-2000
  • Fax:
Mailing address:
  • Phone: 918-694-1474
  • Fax: 918-366-1028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4215
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO2022-0067
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDO2022-0067
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: