MEDICARE: NATHAN G 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	2086S0122X	Plastic and Reconstructive Surgery Physician	8858699-1205	UT
2	2086S0122X	Plastic and Reconstructive Surgery Physician	ME94005	FL
3	2086S0122X	Plastic and Reconstructive Surgery Physician	24920	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	DC3959	OTHER	OK	RR MEDICARE
5	P01126512	OTHER	OK	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8W0850	OTHER	TX	BC/BS OF TEXAS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831161363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN G MILLER M.D.

Provider Business Mailing Address
First Line	:	6440 S WASATCH BLVD
Second Line	:
City	:	HOLLADAY
State	:	UT
Zip	:	84121-3511
Country	:	US
Telephone Number	:	918-786-7780
Fax Number	:

Provider Business Practice Location Address
First Line	:	6440 S WASATCH BLVD
Second Line	:
City	:	HOLLADAY
State	:	UT
Zip	:	84121-3511
Country	:	US
Telephone Number	:	918-786-7780
Fax Number	:

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	11/14/2024

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