Healthcare Provider Details

I. General information

NPI: 1194991828
Provider Name (Legal Business Name): CARL EUGENE MILLER JR. D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 S 101ST EAST AVE STE 190
TULSA OK
74133-5799
US

IV. Provider business mailing address

9001 S 101ST EAST AVE STE 190
TULSA OK
74133-5799
US

V. Phone/Fax

Practice location:
  • Phone: 918-294-6460
  • Fax: 918-294-6469
Mailing address:
  • Phone: 918-294-6460
  • Fax: 918-294-6469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number277
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: