MEDICARE: GORDON A MILLER MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	MD11962	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	756183994	OTHER	OR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235325473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GORDON A MILLER MD PC

Provider Business Mailing Address
First Line	:	2001 COMMERCIAL ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-5207
Country	:	US
Telephone Number	:	503-363-1500
Fax Number	:	503-588-2028

Provider Business Practice Location Address
First Line	:	2001 COMMERCIAL ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-5207
Country	:	US
Telephone Number	:	503-363-1500
Fax Number	:	503-588-2028

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GORDON A MILLER
Credential	:	MD
Telephone Number	:	503-363-1500

Provider Enumeration Date	:	09/21/2007
Last Update Date	:	06/24/2008

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