Provider Demographics
NPI:1194957530
Name:BRAD MILLER DO PA
Entity type:Organization
Organization Name:BRAD MILLER DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-596-0109
Mailing Address - Street 1:945 HILLTOP DR
Mailing Address - Street 2:STE 101
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5891
Mailing Address - Country:US
Mailing Address - Phone:817-596-0109
Mailing Address - Fax:817-594-3777
Practice Address - Street 1:945 HILLTOP DR
Practice Address - Street 2:STE 101
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5891
Practice Address - Country:US
Practice Address - Phone:817-596-0109
Practice Address - Fax:817-594-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-19
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031748901Medicaid
TX00A69NMedicare PIN
TX0A5501Medicare PIN