Healthcare Provider Details

I. General information

NPI: 1114010006
Provider Name (Legal Business Name): JEFFREY HAINLIN MILLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 PLANTATION ROAD
MOHAVE VALLEY AZ
86440
US

IV. Provider business mailing address

1607 PLANTATION ROAD
MOHAVE VALLEY AZ
86440
US

V. Phone/Fax

Practice location:
  • Phone: 928-346-4679
  • Fax: 928-346-4686
Mailing address:
  • Phone: 928-346-4679
  • Fax: 928-346-4686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number006095
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS006293L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: