MEDICARE: LON 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	207P00000X	Emergency Medicine Physician	M6077	ID
2	207P00000X	Emergency Medicine Physician	MD00030099	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760406771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LON MILLER MD

Provider Business Mailing Address
First Line	:	4120 W SOFT WIND DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85310-4000
Country	:	US
Telephone Number	:	509-336-3775
Fax Number	:	623-547-7196

Provider Business Practice Location Address
First Line	:	4120 W SOFT WIND DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85310-4000
Country	:	US
Telephone Number	:	509-336-3775
Fax Number	:	623-547-7196

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	10/27/2011

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Directions to “ LON MILLER MD” Practice Location

Language	Start Address	Practice Location

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