Healthcare Provider Details

I. General information

NPI: 1437136322
Provider Name (Legal Business Name): JAMIE MARCUS MILLER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AMALIA DR
BUCKHANNON WV
26201-2239
US

IV. Provider business mailing address

1 AMALIA DR
BUCKHANNON WV
26201-2239
US

V. Phone/Fax

Practice location:
  • Phone: 304-473-2063
  • Fax:
Mailing address:
  • Phone: 304-473-2063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1873
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1873
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: