Provider Demographics
NPI:1205838075
Name:MILLER, DEBBIE L (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBBIE
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2565 NW LOVEJOY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2846
Mailing Address - Country:US
Mailing Address - Phone:503-279-9700
Mailing Address - Fax:503-279-8114
Practice Address - Street 1:2565 NW LOVEJOY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2846
Practice Address - Country:US
Practice Address - Phone:503-279-9700
Practice Address - Fax:503-279-8114
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD16346207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000BJBLZMedicare PIN
ORE36770Medicare UPIN