Provider Demographics
NPI:1427441633
Name:MILLER, ELROY
Entity type:Individual
Prefix:MR
First Name:ELROY
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 BOULDER CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-1718
Mailing Address - Country:US
Mailing Address - Phone:337-580-3107
Mailing Address - Fax:337-857-2712
Practice Address - Street 1:407 BOULDER CREEK PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-1718
Practice Address - Country:US
Practice Address - Phone:337-580-3107
Practice Address - Fax:337-857-2712
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA47-3230810251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care