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General NPI Number Information
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NPI Number | 1346462157
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Entity Type | Individual
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Provider Name | VICTOR JEROME MILLER ATC
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Gender | Male
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1800 SOUTH 4TH STREET
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City | AMES
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State | IA
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Zip | 50011
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Country | US
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Telephone | 515-294-4307
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Fax | 515-294-6554
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Provider Business Mailing Address
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Address Line | 2801 SW 28TH STREET
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City | ANKENY
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State | IA
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Zip | 50023
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Country | US
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Telephone | 515-289-3791
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 00293
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License Number State | IA
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