Provider Demographics
NPI:1124054291
Name:MILLER HAMRICK, PATRICIA KAY (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA KAY
Middle Name:
Last Name:MILLER HAMRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4527
Mailing Address - Country:US
Mailing Address - Phone:970-708-9392
Mailing Address - Fax:
Practice Address - Street 1:520 E 6TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4527
Practice Address - Country:US
Practice Address - Phone:970-708-9392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL140092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051524743OtherBLUE CROSS
MS06522531OtherMISSISSIPPI MEDICAID
AL009971765Medicaid
AL051534282OtherBLUE CROSS
AL010033CE49999OtherSECTION 1011
AL051525047OtherBLUE CROSS
AL051524740OtherBLUE CROSS
AL051524741OtherBLUE CROSS
AL300059305OtherRAILROAD MEDICARE
AL009971795Medicaid
ALE49999OtherVIVA
AL009936891Medicaid
AL009971775Medicaid
AL009971785Medicaid
AL051524740OtherBLUE CROSS