Provider Demographics
NPI:1194991828
Name:MILLER, CARL EUGENE JR (DPM)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:EUGENE
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9001 S 101ST EAST AVE STE 190
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5799
Mailing Address - Country:US
Mailing Address - Phone:918-294-6460
Mailing Address - Fax:918-294-6469
Practice Address - Street 1:9001 S 101ST EAST AVE STE 190
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5799
Practice Address - Country:US
Practice Address - Phone:918-294-6460
Practice Address - Fax:918-294-6469
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK277213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200724730AMedicaid