Healthcare Provider Details

I. General information

NPI: 1447340112
Provider Name (Legal Business Name): GARY PRICE MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 EXECUTIVE DRIVE
DANVILLE VA
24541-4100
US

IV. Provider business mailing address

158 EXECUTIVE DRIVE
DANVILLE VA
24541-4100
US

V. Phone/Fax

Practice location:
  • Phone: 434-791-1088
  • Fax: 434-799-8525
Mailing address:
  • Phone: 434-791-1088
  • Fax: 434-799-8525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number13684
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number38394
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0101028975
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101028975
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number0101028975
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: