1841211752 NPI number — JAN ESTES MILLER MD

Table of content: JAN ESTES MILLER MD (NPI 1841211752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841211752 NPI number — JAN ESTES MILLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
JAN
Provider Middle Name:
ESTES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHMIDT
Provider Other First Name:
JAN
Provider Other Middle Name:
ESTES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841211752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 269064
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73126-9064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-231-3857
Provider Business Mailing Address Fax Number:
405-272-7977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
608 NW 9TH ST
Provider Second Line Business Practice Location Address:
SUITE 1100
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73102-1068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-231-3000
Provider Business Practice Location Address Fax Number:
405-231-3073
Provider Enumeration Date:
07/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  19851 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100229570D , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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