Healthcare Provider Details

I. General information

NPI: 1629266374
Provider Name (Legal Business Name): DAVID S MILLER MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/23/2011
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 NumberMD12022
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: DR. DAVID S MILLER
Title or Position: OWNER
Credential: MD
Phone: 541-341-3717