Healthcare Provider Details

I. General information

NPI: 1265429765
Provider Name (Legal Business Name): ROBERT H MILLER III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 MARKET BLVD STE 103
COLLIERVILLE TN
38017-2360
US

IV. Provider business mailing address

511 MARKET BLVD STE 103
COLLIERVILLE TN
38017-2360
US

V. Phone/Fax

Practice location:
  • Phone: 901-850-1150
  • Fax: 901-850-1102
Mailing address:
  • Phone: 901-850-1150
  • Fax: 901-850-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number13789
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: