MEDICARE: JOHN E MILLER PA-C

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	363AM0700X	Medical Physician Assistant	PA-2548	CO
2	363A00000X	Physician Assistant	PA18794	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0002548	OTHER	CO	STATE LICENSE

General Provider Information

NPI Number	:	1396898169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN E MILLER PA-C

Provider Business Mailing Address
First Line	:	300 S NEVADA AVE
Second Line	:
City	:	MONTROSE
State	:	CO
Zip	:	81401-4273
Country	:	US
Telephone Number	:	970-249-7751
Fax Number	:	970-249-5029

Provider Business Practice Location Address
First Line	:	2454 HWY 6 AND 50 STE 104
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1117
Country	:	US
Telephone Number	:	970-249-7751
Fax Number	:

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	06/12/2019

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Directions to “ JOHN E MILLER PA-C” Practice Location

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