Provider Demographics
NPI:1386796191
Name:MILLER, SPENCER OWEN (MD)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:OWEN
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7001 PRESTON RD STE 404
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-1187
Mailing Address - Country:US
Mailing Address - Phone:469-466-9745
Mailing Address - Fax:267-367-5939
Practice Address - Street 1:7001 PRESTON RD STE 404
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-1187
Practice Address - Country:US
Practice Address - Phone:469-466-9745
Practice Address - Fax:267-367-5939
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS198532084N0400X
NV131572084N0400X
TXQ48102084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1386796191Medicaid
AZ1386796191Medicaid
UT1386796191Medicaid
AU50096970944Medicare UPIN
AZ1386796191Medicaid