Healthcare Provider Details

I. General information

NPI: 1740985571
Provider Name (Legal Business Name): BROC DOUGLAS MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 BEN BOLT AVE
TAZEWELL VA
24651-5386
US

IV. Provider business mailing address

PO BOX 729
SALTVILLE VA
24370-0729
US

V. Phone/Fax

Practice location:
  • Phone: 276-979-9899
  • Fax: 276-979-9798
Mailing address:
  • Phone: 276-496-4492
  • Fax: 276-496-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101288940
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: