Provider Demographics
NPI:1053702357
Name:MILLER, JAMES EDWARD (RES-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:MILLER
Suffix:
Gender:M
Credentials:RES-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 SHADOW OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-6071
Mailing Address - Country:US
Mailing Address - Phone:832-332-5704
Mailing Address - Fax:
Practice Address - Street 1:2519 SHADOW OAKS DR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-6071
Practice Address - Country:US
Practice Address - Phone:832-332-5704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist