1295093458 NPI number — MILLER FAMILY DERMATOLOGY, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295093458 NPI number — MILLER FAMILY DERMATOLOGY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILLER FAMILY DERMATOLOGY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295093458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 NW GILMAN BLVD
Provider Second Line Business Mailing Address:
301A
Provider Business Mailing Address City Name:
ISSAQUAH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98027-2483
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-654-1275
Provider Business Mailing Address Fax Number:
425-654-0539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 NW GILMAN BLVD
Provider Second Line Business Practice Location Address:
301A
Provider Business Practice Location Address City Name:
ISSAQUAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98027-2483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-654-1275
Provider Business Practice Location Address Fax Number:
425-654-0539
Provider Enumeration Date:
04/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
ARLO
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
425-654-1275

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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