MEDICARE: DR. ROGER W MILLER M.D.

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	207Y00000X	Otolaryngology Physician	MD24790	OR

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	:	1780688523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER W MILLER M.D.

Provider Business Mailing Address
First Line	:	2095 EXCHANGE ST
Second Line	:	SUITE #201
City	:	ASTORIA
State	:	OR
Zip	:	97103-3417
Country	:	US
Telephone Number	:	503-338-4455
Fax Number	:	503-338-4837

Provider Business Practice Location Address
First Line	:	2095 EXCHANGE ST
Second Line	:	SUITE #201
City	:	ASTORIA
State	:	OR
Zip	:	97103-3417
Country	:	US
Telephone Number	:	503-338-4455
Fax Number	:	503-338-4837

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	05/04/2011

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