Provider Demographics
NPI:1114992856
Name:MILLER, GARRON E (MD)
Entity Type:Individual
Prefix:DR
First Name:GARRON
Middle Name:E
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 1:50 S MEDICAL DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-1633
Mailing Address - Country:US
Mailing Address - Phone:801-465-2800
Mailing Address - Fax:
Practice Address - Street 1:50 S MEDICAL DR
Practice Address - Street 2:SUITE 50
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1633
Practice Address - Country:US
Practice Address - Phone:801-465-2235
Practice Address - Fax:801-377-6811
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-29652208000000X
UT61457178905208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870549057Medicaid