Healthcare Provider Details

I. General information

NPI: 1114918067
Provider Name (Legal Business Name): DAVID SCOTT MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 WILLAGILLESPIE RD STE 200
EUGENE OR
97401-2170
US

IV. Provider business mailing address

995 WILLAGILLESPIE RD STE 200
EUGENE OR
97401-2170
US

V. Phone/Fax

Practice location:
  • Phone: 541-341-3717
  • Fax: 541-302-8107
Mailing address:
  • Phone: 541-341-3717
  • Fax: 541-302-8107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12022
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier013532
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: