Provider Demographics
NPI:1033113733
Name:MILLER, JAMES A (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-3616
Mailing Address - Country:US
Mailing Address - Phone:970-522-0591
Mailing Address - Fax:970-526-1708
Practice Address - Street 1:110 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-3616
Practice Address - Country:US
Practice Address - Phone:970-522-0591
Practice Address - Fax:970-526-1708
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2017-02-17
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
CO0028700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01287002Medicaid
D25105Medicare UPIN
COCO300644Medicare PIN