Basic Information
| Provider Information | |||||||||
| NPI: | 1740525195 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | G | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1013 W UNIVERSITY AVE | ||||||||
| Address2: | SUITE 122 | ||||||||
| City: | GEORGETOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786285340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128681100 | ||||||||
| FaxNumber: | 5128681105 | ||||||||
| Practice Location | |||||||||
| Address1: | 1013 W UNIVERSITY AVE | ||||||||
| Address2: | SUITE 122 | ||||||||
| City: | GEORGETOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786285340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128681100 | ||||||||
| FaxNumber: | 5128681105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2012 | ||||||||
| LastUpdateDate: | 12/11/2012 | ||||||||
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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 | 237700000X | 11150 | TX | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.