MEDICARE: MR. FRED DOUGLAS MILLER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	12217	AZ
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	12217	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0725850	OTHER	AZ	BLUE CROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124028220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRED DOUGLAS MILLER MD

Provider Business Mailing Address
First Line	:	15216 N 11TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-3734
Country	:	US
Telephone Number	:	520-241-3183
Fax Number	:	602-866-0684

Provider Business Practice Location Address
First Line	:	2250 N CRAYCROFT RD
Second Line	:	STE 2200
City	:	TUCSON
State	:	AZ
Zip	:	85712-2802
Country	:	US
Telephone Number	:	520-241-3183
Fax Number	:	520-546-3433

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	09/11/2025

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Directions to “ MR. FRED DOUGLAS MILLER MD” Practice Location

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