Provider Demographics
NPI: | 1114047750 |
---|---|
Name: | MILLER, ZACHARY I (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | ZACHARY |
Middle Name: | I |
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: | PO BOX 34581 |
Mailing Address - Street 2: | |
Mailing Address - City: | SEATTLE |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98124-1581 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 509-241-7349 |
Mailing Address - Fax: | 509-241-7628 |
Practice Address - Street 1: | 310 15TH AVE E |
Practice Address - Street 2: | |
Practice Address - City: | SEATTLE |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98112-5103 |
Practice Address - Country: | US |
Practice Address - Phone: | 360-326-3000 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-03-29 |
Last Update Date: | 2009-06-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | MD00014834 | 207RI0200X, 2080P0208X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No | 2080P0208X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WA | 8371908 | Medicaid | |
WA | G000135111 | Medicare PIN | |
WA | E72402 | Medicare UPIN | |
WA | 8371908 | Medicaid |