=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619084415
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER RAY MILLER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 N MEDICAL DR
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84113-1103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-993-9551
-----------------------------------------------------
Fax | 801-733-5872
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3164 S 3075 E
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84109-2147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-487-4252
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 377570-1205
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------