Provider Demographics
NPI:1164413324
Name:MILLER, JOHN PITTS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PITTS
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 1708
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-1708
Mailing Address - Country:US
Mailing Address - Phone:985-230-6700
Mailing Address - Fax:985-230-1528
Practice Address - Street 1:15790 PAUL VEGA MD DR
Practice Address - Street 2:RADIOLOGY
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1434
Practice Address - Country:US
Practice Address - Phone:985-230-6700
Practice Address - Fax:985-230-1528
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD0147702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
300054355OtherRR MEDICARE
MS00113314Medicaid
LA1328782Medicaid
LA53110Medicare ID - Type Unspecified
MS00113314Medicaid
LA1328782Medicaid