Healthcare Provider Details

I. General information

NPI: 1619084415
Provider Name (Legal Business Name): CHRISTOPHER RAY MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MEDICAL DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

3164 S 3075 E
SALT LAKE CITY UT
84109-2147
US

V. Phone/Fax

Practice location:
  • Phone: 801-993-9551
  • Fax: 801-733-5872
Mailing address:
  • Phone: 801-487-4252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number377570-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: