Individual
ALEXANDER MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1410 S. GIN ROAD, ATOKA, OK 74525-0000
(580) 889-3399
Mailing address
9613 MAYBROOK DR, OKLAHOMA CITY, OK 73159-6555
(405) 388-6717
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200287120A
—
OK
Enumeration date
06/20/2012
Last updated
06/20/2012
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