MEDICARE: MOLLY J 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	363A00000X	Physician Assistant	PA.0000737	CO

General Provider Information

NPI Number	:	1548295843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY J MILLER PA-C

Provider Business Mailing Address
First Line	:	1735 S PUBLIC RD STE 203
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-7093
Country	:	US
Telephone Number	:	303-665-3036
Fax Number	:	303-665-3397

Provider Business Practice Location Address
First Line	:	8510 BRYANT ST STE 200
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80031-3845
Country	:	US
Telephone Number	:	303-449-6050
Fax Number	:	720-565-4130

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	05/18/2021

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