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General NPI Number Information
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NPI Number | 1316270168
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Entity Type | Individual
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Provider Name | IAN DOUGLAS MILLER PA
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Gender | Male
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Dates
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Enumeration Date | 09/11/2009
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Last Update Date | 07/06/2016
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Provider Practice Location Address
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Address Line | 198 FOUR STATES DR. SUITE 1
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City | GALENA
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State | KS
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Zip | 66739-4305
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Country | US
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Telephone | 620-783-2356
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Fax | 620-783-2395
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Provider Business Mailing Address
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Address Line | 198 FOUR STATES DR STE 1
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City | GALENA
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State | KS
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Zip | 66739-4305
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Country | US
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Telephone | 620-783-2356
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Fax | 620-783-2395
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2009026344
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License Number State | MO
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