Healthcare Provider Details

I. General information

NPI: 1174936124
Provider Name (Legal Business Name): REBECCA MARIE-RAUB MILLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA MARIE RAUB MD

II. Dates (important events)

Enumeration Date: 06/07/2014
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N BEAVER ST BLDG 6
FLAGSTAFF AZ
86001-3148
US

IV. Provider business mailing address

707 N ALVERNON WAY SUITE 101
TUCSON AZ
85711-1827
US

V. Phone/Fax

Practice location:
  • Phone: 928-527-4325
  • Fax:
Mailing address:
  • Phone: 520-694-1614
  • Fax: 520-694-1428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR74644
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number53211
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: