MEDICARE: DR. JENNIFER LYNN MILLER D.O.

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	1349	VI
2	207Q00000X	Family Medicine Physician	3606	AZ

General Provider Information

NPI Number	:	1558362715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER LYNN MILLER D.O.

Provider Business Mailing Address
First Line	:	5055 E BROADWAY BLVD STE A100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3629
Country	:	US
Telephone Number	:	520-327-0460
Fax Number	:

Provider Business Practice Location Address
First Line	:	2155 W ORANGE GROVE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-3118
Country	:	US
Telephone Number	:	520-742-0414
Fax Number	:	520-742-6635

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	02/15/2024

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