Provider Demographics
NPI:1275606089
Name:MILLER, BRUCE ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:ALLAN
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 1:3337 N MILLER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6436
Mailing Address - Country:US
Mailing Address - Phone:480-947-1221
Mailing Address - Fax:480-947-0337
Practice Address - Street 1:3337 N MILLER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6436
Practice Address - Country:US
Practice Address - Phone:480-947-1221
Practice Address - Fax:480-947-0337
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8399207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1989OtherHEALTHNET ID
AZ238990Medicaid
AZ238990Medicaid