Provider Demographics
NPI:1538262407
Name:MILLER, SUSAN LEE (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1045 CENTRAL PKWY N
Mailing Address - Street 2:SUITE #200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5085
Mailing Address - Country:US
Mailing Address - Phone:210-536-9591
Mailing Address - Fax:904-425-2949
Practice Address - Street 1:1860 S SEGUIN AVE
Practice Address - Street 2:BLDG E.
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3914
Practice Address - Country:US
Practice Address - Phone:830-626-7770
Practice Address - Fax:855-278-4535
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK2246207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK2246OtherTX LICENSE
TX353971002Medicaid
TXK2246OtherTX LICENSE
TXPENDINGMedicare PIN