Healthcare Provider Details

I. General information

NPI: 1053576215
Provider Name (Legal Business Name): MARK LELAND MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2008
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 SW SAM JACKSON PARK RD STE 1B
PORTLAND OR
97239-3095
US

IV. Provider business mailing address

3101 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3095
US

V. Phone/Fax

Practice location:
  • Phone: 503-221-3424
  • Fax: 503-221-3490
Mailing address:
  • Phone: 503-221-3424
  • Fax: 503-221-3490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberMD229197
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD229197
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: