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General NPI Number Information
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NPI Number | 1356828305
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Entity Type | Organization
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Legal Business Name | DR. PETERYNE D. MILLER, M.D. LLC
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Dates
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Enumeration Date | 07/23/2018
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Last Update Date | 07/23/2018
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Provider Practice Location Address
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Address Line | 4870 S LEWIS AVE STE 205
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City | TULSA
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State | OK
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Zip | 74105-5153
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Country | US
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Telephone | 918-863-2910
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Fax |
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Provider Business Mailing Address
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Address Line | 4870 S LEWIS AVE STE 205
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City | TULSA
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State | OK
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Zip | 74105-5153
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MAANGER
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Name | JENNIFER OWENS
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Credential |
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Telephone | 918-863-2910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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