Healthcare Provider Details

I. General information

NPI: 1548497225
Provider Name (Legal Business Name): JASON MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MARTIN LUTHER KING JR WAY MAIL STOP 315-02-TGE
TACOMA WA
98405-4234
US

IV. Provider business mailing address

4302 N STEVENS ST
TACOMA WA
98407-6612
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-4901
  • Fax:
Mailing address:
  • Phone: 303-818-0701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMT194867
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: