Provider Demographics
NPI:1144338088
Name:MILLER, GARLAND DUPREE (MD)
Entity type:Individual
Prefix:DR
First Name:GARLAND
Middle Name:DUPREE
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1068
Mailing Address - Street 2:2114 OBRIE STREET
Mailing Address - City:ZWOLLE
Mailing Address - State:LA
Mailing Address - Zip Code:71486
Mailing Address - Country:US
Mailing Address - Phone:318-645-4484
Mailing Address - Fax:318-645-9139
Practice Address - Street 1:2114 OBRIE STREET
Practice Address - Street 2:
Practice Address - City:ZWOLLE
Practice Address - State:LA
Practice Address - Zip Code:71486
Practice Address - Country:US
Practice Address - Phone:318-645-4484
Practice Address - Fax:318-645-9139
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA16359261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1321702Medicaid
LAB64363Medicare UPIN
LA1321702Medicaid