Healthcare Provider Details

I. General information

NPI: 1225089790
Provider Name (Legal Business Name): GREGORY J MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WOODLAND RD
SAINT HELENA CA
94574-9554
US

IV. Provider business mailing address

1121 E 3900 S STE C240
SALT LAKE CITY UT
84124-1214
US

V. Phone/Fax

Practice location:
  • Phone: 707-967-5721
  • Fax:
Mailing address:
  • Phone: 801-262-9494
  • Fax: 801-262-0507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberG149823
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number259833-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: