Individual
KEVIN L MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 SAN GABRIEL VILLAGE BLVD, STE 105, GEORGETOWN, TX 78626-5594
(512) 819-9910
(512) 819-9970
Mailing address
700 SAN GABRIEL VILLAGE BLVD, STE 105, GEORGETOWN, TX 78626-5594
(512) 819-9910
(512) 819-9970
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
L1393
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0034KL
BLUE CROSS
TX
01
—
7524367
AETNA ID
TX
Enumeration date
03/31/2006
Last updated
08/23/2011
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