Healthcare Provider Details

I. General information

NPI: 1114992856
Provider Name (Legal Business Name): GARRON E MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S MEDICAL DR SUITE 50
PAYSON UT
84651-1633
US

IV. Provider business mailing address

50 S MEDICAL DR SUITE 2
PAYSON UT
84651-1633
US

V. Phone/Fax

Practice location:
  • Phone: 801-465-2235
  • Fax: 801-377-6811
Mailing address:
  • Phone: 801-465-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-29652
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number61457178905
License Number StateUT

VII. Legacy identifiers

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

# 1
Identifier870549057
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: