Provider Demographics
NPI:1730157405
Name:MILLER, VICKI ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:VICKI
Middle Name:ELIZABETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:524 PASADENA BLVD
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77506-2462
Mailing Address - Country:US
Mailing Address - Phone:713-554-1091
Mailing Address - Fax:713-554-1096
Practice Address - Street 1:524 PASADENA BLVD
Practice Address - Street 2:SUITE 1001
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77506-2462
Practice Address - Country:US
Practice Address - Phone:713-554-1091
Practice Address - Fax:713-554-1096
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1262207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D2728Medicare ID - Type Unspecified
TXG76765Medicare UPIN