1700453784 NPI number — JON L MILLER MD

Table of content: JON L MILLER MD (NPI 1700453784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700453784 NPI number — JON L MILLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
JON
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1700453784
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
WSU FAMILY MEDICINE RESIDENCY
Provider Second Line Business Mailing Address:
2261 PHILADELPHIA DRIVE SUITE 300
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 CRAIG KLAWOCK HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRAIG
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99921-0678
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-826-3257
Provider Business Practice Location Address Fax Number:
907-228-8515
Provider Enumeration Date:
06/08/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 226230 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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