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NPI Code Detail

MEDICARE: JESSE MILLER DO

MEDICARE: JESSE MILLER DO
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine Physician12323AWY

General Provider Information

NPI Number : 1972023885
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSE MILLER DO
Provider Business Mailing Address
First Line : 1510 S CEDAR ST
Second Line :
City : CASPER
State : WY
Zip : 82601-4141
Country : US
Telephone Number : 307-200-9669
Fax Number :
Provider Business Practice Location Address
First Line : 1233 E 2ND ST
Second Line :
City : CASPER
State : WY
Zip : 82601-2988
Country : US
Telephone Number : 307-577-7201
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2017
Last Update Date : 07/21/2022

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