Healthcare Provider Details

I. General information

NPI: 1316957574
Provider Name (Legal Business Name): DWAYNE C MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 HIGHWAY 16
COMANCHE TX
76442-4462
US

IV. Provider business mailing address

6610 HWY 2318
COMANCHE TX
76442-6622
US

V. Phone/Fax

Practice location:
  • Phone: 254-879-4910
  • Fax: 254-879-4990
Mailing address:
  • Phone: 254-879-4910
  • Fax: 254-879-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0638
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: