Basic Information
| Provider Information | |||||||||
| NPI: | 1225050669 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | B. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5865 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794085865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432898 | ||||||||
| FaxNumber: | 8067432787 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 4TH ST | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794308115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432155 | ||||||||
| FaxNumber: | 8067432117 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 05/08/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZN0500X | 0101239526 | VA | Y | Allopathic & Osteopathic Physicians | Pathology | Neuropathology | 207ZN0500X | N8042 | TX | N | Allopathic & Osteopathic Physicians | Pathology | Neuropathology | 207ZP0102X | N8042 | TX | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 192721100 | 01 | TX | FIRSTCARE | OTHER | 8CR252 | 01 | TX | HMO BLUE | OTHER | 43639208 | 05 | NM | MEDICAID | 8CR251 | 01 | TX | BC/BS | OTHER |