Healthcare Provider Details

I. General information

NPI: 1760454060
Provider Name (Legal Business Name): STEPHEN MILLER M.D. P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8431 FREDERICKSBURG RD SUITE 100
SAN ANTONIO TX
78229-3364
US

IV. Provider business mailing address

8431 FREDERICKSBURG RD SUITE 100
SAN ANTONIO TX
78229-3364
US

V. Phone/Fax

Practice location:
  • Phone: 210-615-7171
  • Fax: 210-615-6793
Mailing address:
  • Phone: 210-615-7171
  • Fax: 210-615-6793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberJ7586
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: