Healthcare Provider Details

I. General information

NPI: 1043487200
Provider Name (Legal Business Name): DODXRX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 YAMPA AVE SUITE 300
CRAIG CO
81625-2627
US

IV. Provider business mailing address

535 YAMPA AVE SUITE 300
CRAIG CO
81625-2627
US

V. Phone/Fax

Practice location:
  • Phone: 970-824-6530
  • Fax: 970-826-0915
Mailing address:
  • Phone: 970-824-6530
  • Fax: 970-826-0915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33778
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JOEL E MILLER
Title or Position: OWNER
Credential: D.O.
Phone: 970-824-6530