Healthcare Provider Details

I. General information

NPI: 1770553067
Provider Name (Legal Business Name): FRANK DENTON MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 02/29/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 JOE T PETTY DRIVE
RUSSELL SPRINGS KY
42642
US

IV. Provider business mailing address

92 JOE T PETTY DRIVE
RUSSELL SPRINGS KY
42642
US

V. Phone/Fax

Practice location:
  • Phone: 270-866-7611
  • Fax: 270-866-7613
Mailing address:
  • Phone: 270-866-7611
  • Fax: 270-866-7613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15873
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: