Healthcare Provider Details

I. General information

NPI: 1891899829
Provider Name (Legal Business Name): GREGORY A MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 W ELM ST
LEBANON MO
65536-3523
US

IV. Provider business mailing address

54 HOSPITAL DR
OSAGE BEACH MO
65065-3050
US

V. Phone/Fax

Practice location:
  • Phone: 417-532-2805
  • Fax: 417-532-2848
Mailing address:
  • Phone: 573-348-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2007033180
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: