Healthcare Provider Details

I. General information

NPI: 1255566196
Provider Name (Legal Business Name): BRIAN K MILLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 MEDICAL PARK DR FIRST FLOOR
MARION VA
24354-1100
US

IV. Provider business mailing address

245 MEDICAL PARK DR FIRST FLOOR
MARION VA
24354-1100
US

V. Phone/Fax

Practice location:
  • Phone: 276-378-1341
  • Fax: 276-378-1345
Mailing address:
  • Phone: 423-302-6882
  • Fax: 423-952-2147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4931
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: