Healthcare Provider Details

I. General information

NPI: 1336169952
Provider Name (Legal Business Name): ARCHIBALD SANFORD MILLER III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6585 S YALE AVE SUITE 315
TULSA OK
74136-8384
US

IV. Provider business mailing address

6585 S YALE AVE SUITE 315
TULSA OK
74136-8384
US

V. Phone/Fax

Practice location:
  • Phone: 918-492-2282
  • Fax: 918-491-9188
Mailing address:
  • Phone: 918-492-2282
  • Fax: 918-491-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number15653
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: