Doctor Name: | DR. ALISA ANNE MILLER |
NPI Number: | 1922367242 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.O. |
License Number: | 0102203712 |
Business Practice Address: | 2200 Bergquist Dr. Wilford Hall Amb Surgical Center Lackland Afb, TX - 782369908 |
Business Phone Number: | 2102927805 |
Business Fax Number: | 2102927868 |
Mailing Address: | 2200 Bergquist Dr., Wilford Hall Ambulatory Surg Center LACKLAND AFB |
State: | TX |
Postal Code: | 782369908 |
Phone Number: | 2102927805 |
Fax Number: | 2102927868 |
NPI Enumeration Date: | 05/07/2012 |
NPI Last Update Date: | 09/18/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 0102203712 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |