Healthcare Provider Details

I. General information

NPI: 1639231525
Provider Name (Legal Business Name): JAMES M MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 COOKS HILL RD.
CENTRALIA WA
98531
US

IV. Provider business mailing address

1911 COOKS HILL RD.
CENTRALIA WA
98531
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-6778
  • Fax: 360-736-6552
Mailing address:
  • Phone: 360-736-6778
  • Fax: 360-736-6552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00029916
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: