Provider Demographics
NPI:1053302232
Name:MILLER, GORDON BERYL JR (DO)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:BERYL
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:205 GRANDVIEW AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1211 FORGE ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013
Practice Address - Country:US
Practice Address - Phone:717-218-3920
Practice Address - Fax:717-218-3921
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS013018207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine