Healthcare Provider Details

I. General information

NPI: 1518936913
Provider Name (Legal Business Name): WILLIAM SMITH MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S PRESTON ST STE A
RANSON WV
25438-1675
US

IV. Provider business mailing address

201 S PRESTON ST STE A
RANSON WV
25438-1675
US

V. Phone/Fax

Practice location:
  • Phone: 304-725-6514
  • Fax: 304-725-3781
Mailing address:
  • Phone: 304-725-6514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12485
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: