Healthcare Provider Details

I. General information

NPI: 1538208525
Provider Name (Legal Business Name): MARY EULALIA MILLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N GRAHAM ST STE 250
PORTLAND OR
97227-1651
US

IV. Provider business mailing address

2051 KAEN RD STE 367
OREGON CITY OR
97045-4035
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-2902
  • Fax:
Mailing address:
  • Phone: 503-742-5300
  • Fax: 503-742-5359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD28552
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: