Provider Demographics
NPI:1114918067
Name:MILLER, DAVID SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
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 1:995 WILLAGILLESPIE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2170
Mailing Address - Country:US
Mailing Address - Phone:541-341-3717
Mailing Address - Fax:541-302-8107
Practice Address - Street 1:995 WILLAGILLESPIE RD
Practice Address - Street 2:STE 200
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2170
Practice Address - Country:US
Practice Address - Phone:541-341-3717
Practice Address - Fax:541-302-8107
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12022208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR013532Medicaid
ORC93316Medicare UPIN