Provider Demographics
NPI:1528243128
Name:JASON MILLER DPM PA
Entity type:Organization
Organization Name:JASON MILLER DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAREN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GUERTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:281-348-2166
Mailing Address - Street 1:350 KINGWOOD MEDICAL DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-6405
Mailing Address - Country:US
Mailing Address - Phone:281-348-2166
Mailing Address - Fax:281-358-2153
Practice Address - Street 1:350 KINGWOOD MEDICAL DR
Practice Address - Street 2:SUITE 150
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-6405
Practice Address - Country:US
Practice Address - Phone:281-348-2166
Practice Address - Fax:281-358-2153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1780213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1639368970OtherGROUP NPI
TX177385501Medicaid
TX183615702Medicaid
TX5859070001Medicare NSC
TXV10881Medicare UPIN
TX183615702Medicaid
TX00609ZMedicare PIN
TX5541990001Medicare NSC