Healthcare Provider Details

I. General information

NPI: 1659329928
Provider Name (Legal Business Name): ALAN PAUL MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 STIERMAN WAY
EAGLE ID
83616-5163
US

IV. Provider business mailing address

125 STIERMAN WAY
EAGLE ID
83616-5163
US

V. Phone/Fax

Practice location:
  • Phone: 208-939-4880
  • Fax: 208-939-5003
Mailing address:
  • Phone: 208-939-4880
  • Fax: 208-939-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM6036
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: