Provider Demographics
NPI:1215230651
Name:MILLER, JESS RANSOM (MD)
Entity Type:Individual
Prefix:DR
First Name:JESS
Middle Name:RANSOM
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1497 W ELK AVE
Mailing Address - Street 2:SUITE 21
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2895
Mailing Address - Country:US
Mailing Address - Phone:423-542-7420
Mailing Address - Fax:423-542-7425
Practice Address - Street 1:250 W MARQUAM ST
Practice Address - Street 2:
Practice Address - City:MOUNT ANGEL
Practice Address - State:OR
Practice Address - Zip Code:97362
Practice Address - Country:US
Practice Address - Phone:503-845-2000
Practice Address - Fax:503-845-2384
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101247988207Q00000X
TN53724207Q00000X
OR186079207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1215230651Medicaid
TNQ021281Medicaid
VA1215230651Medicaid