Healthcare Provider Details

I. General information

NPI: 1235628918
Provider Name (Legal Business Name): JUDD MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E COPLIN ST
OKEMAH OK
74859-4642
US

IV. Provider business mailing address

10109 E 79TH ST
TULSA OK
74133-4564
US

V. Phone/Fax

Practice location:
  • Phone: 918-623-1424
  • Fax:
Mailing address:
  • Phone: 918-888-5211
  • Fax: 918-888-5270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number6708
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number6708
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: