Healthcare Provider Details

I. General information

NPI: 1245265610
Provider Name (Legal Business Name): PAUL R MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 5TH ST
RAPID CITY SD
57701-6003
US

IV. Provider business mailing address

2805 5TH ST
RAPID CITY SD
57701-6003
US

V. Phone/Fax

Practice location:
  • Phone: 605-755-5700
  • Fax: 605-755-5716
Mailing address:
  • Phone: 605-755-5700
  • Fax: 605-755-5716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number14516
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberV2906
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number9752
License Number StateSD
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberV2906
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: