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NPI Code Detail

MEDICARE: BLAKE PATRICK MILLER PA-S

MEDICARE: BLAKE PATRICK MILLER PA-S
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
1390200000XStudent in an Organized Health Care Education/Training Program
2363A00000XPhysician AssistantCO

General Provider Information

NPI Number : 1588519078
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLAKE PATRICK MILLER PA-S
Provider Business Mailing Address
First Line : 1100 NORTH AVE
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81501-3122
Country : US
Telephone Number : 970-248-1020
Fax Number :
Provider Business Practice Location Address
First Line : 1100 NORTH AVE
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81501-3122
Country : US
Telephone Number : 970-248-1020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2026
Last Update Date : 03/02/2026

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Directions to “ BLAKE PATRICK MILLER PA-S” Practice Location

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