Healthcare Provider Details

I. General information

NPI: 1508905704
Provider Name (Legal Business Name): JEFFREY A MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 SW 30TH CT STE A
MOORE OK
73160-2887
US

IV. Provider business mailing address

1109 SW 30TH CT STE A
MOORE OK
73160-2887
US

V. Phone/Fax

Practice location:
  • Phone: 405-703-0937
  • Fax:
Mailing address:
  • Phone: 405-703-0937
  • Fax: 888-290-8567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25175
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25175
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: