Healthcare Provider Details

I. General information

NPI: 1467721456
Provider Name (Legal Business Name): DAVID STEVEN MILLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7773 W LIBBY ST
GLENDALE AZ
85308-8240
US

IV. Provider business mailing address

3039 W PEORIA AVE STE.C102-613
PHOENIX AZ
85029-5212
US

V. Phone/Fax

Practice location:
  • Phone: 623-687-6786
  • Fax: 623-334-1389
Mailing address:
  • Phone: 623-687-6786
  • Fax: 623-334-1389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number03206
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: