Healthcare Provider Details

I. General information

NPI: 1013833631
Provider Name (Legal Business Name): COOPER CAMERON MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11280 WHITE SETTLEMENT RD
FT WORTH TX
76108-4716
US

IV. Provider business mailing address

4600 MUELLER BLVD APT 2075
AUSTIN TX
78723-3297
US

V. Phone/Fax

Practice location:
  • Phone: 832-938-2534
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: