Healthcare Provider Details

I. General information

NPI: 1811988835
Provider Name (Legal Business Name): WILLIAM JESS MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 11/08/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 N PORTLAND STE. 440
OKLAHOMA CITY OK
73112
US

IV. Provider business mailing address

5401 N PORTLAND STE. 440
OKLAHOMA CITY OK
73112
US

V. Phone/Fax

Practice location:
  • Phone: 405-943-1137
  • Fax: 405-947-0731
Mailing address:
  • Phone: 405-943-1137
  • Fax: 405-947-0731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number13146
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: