NPIMap

Organization Active NPI

Kevin L Miller MD, PA

Doing business as Georgetown Dermatology and Skin Cancer Center

  • Dermatology Physician
  • Georgetown, TX
National Provider Identifier
1548451610
Registry record updated Aug 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
L1393 Issued in TX
Legal business name
KEVIN L MILLER MD, PA
Doing business as
Georgetown Dermatology and Skin Cancer Center
Practice address
700 San Gabriel Village Blvd
Ste 105
Georgetown, TX 78626-5594
Phone
(512) 819-9910
Fax
(512) 819-9970
NPI assigned
Aug 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kevin L Miller, MDNPI 1821059395
Title
President
Phone
(512) 819-9910

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X L1393 TX Primary

Addresses

Primary practice location

700 San Gabriel Village Blvd
Ste 105
Georgetown, TX 78626-5594

Mailing address

700 San Gabriel Village Blvd
Ste 105
Georgetown, TX 78626-5594
Phone (512) 819-9910

Other identifiers 3

IdentifierTypeStateIssuer
283939OtherTXSCOTT AND WHITE
7524367OtherTXAETNA
DA4188OtherTXRAIL ROAD MEDICARE

Other names 1

  • GEORGETOWN DERMATOLOGY AND SKIN CANCER CENTER Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314057600000",
    "number": "1548451610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 SAN GABRIEL VILLAGE BLVD",
            "address_2": "STE 105",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786265594",
            "telephone_number": "512-819-9910",
            "fax_number": "512-819-9970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 SAN GABRIEL VILLAGE BLVD",
            "address_2": "STE 105",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786265594",
            "telephone_number": "512-819-9910",
            "fax_number": "512-819-9970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN L MILLER MD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-05",
        "last_updated": "2011-08-23",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-819-9910",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": "L1393",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SCOTT AND WHITE",
            "identifier": "283939",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7524367",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "DA4188",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GEORGETOWN DERMATOLOGY AND SKIN CANCER CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Georgetown, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.