Healthcare Provider Details

I. General information

NPI: 1770531204
Provider Name (Legal Business Name): ANTHONY J MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 S RANCHO DR
LAS VEGAS NV
89106-3810
US

IV. Provider business mailing address

PO BOX 4934
ALBUQUERQUE NM
87196-4934
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-5125
  • Fax: 702-877-8370
Mailing address:
  • Phone: 505-298-0301
  • Fax: 505-998-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD2009-0544
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.089451
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number40744
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number234069
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDR.0067712
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036167592
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: