Healthcare Provider Details

I. General information

NPI: 1427575661
Provider Name (Legal Business Name): JAKE MILLER MD, MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

1959 NE PACIFIC ST
SEATTLE WA
98195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 206-221-1509
  • Fax:
Mailing address:
  • Phone: 206-221-1509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD.MD.70090287
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: