Healthcare Provider Details

I. General information

NPI: 1699777409
Provider Name (Legal Business Name): CHRISTOPHER DANIEL MILLER M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 RIFE MEDICAL LANE STE 300
ROGERS AR
72758
US

IV. Provider business mailing address

2708 RIFE MEDICAL LANE STE 300
ROGERS AR
72758
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-3030
  • Fax: 479-338-3079
Mailing address:
  • Phone: 479-338-3030
  • Fax: 479-338-3079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35339
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: