Healthcare Provider Details

I. General information

NPI: 1407810575
Provider Name (Legal Business Name): JOHN CARLYLE MILLER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 ESCALANTE DR STE 201
DURANGO CO
81303-8934
US

IV. Provider business mailing address

1266 ESCALANTE DR STE 201
DURANGO CO
81303-8934
US

V. Phone/Fax

Practice location:
  • Phone: 970-259-5303
  • Fax: 970-259-3510
Mailing address:
  • Phone: 970-259-5303
  • Fax: 970-259-3510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number467
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number48
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0000909
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: