Provider Demographics
NPI:1326455957
Name:MILLER, DANE E (PA)
Entity Type:Individual
Prefix:
First Name:DANE
Middle Name:E
Last Name:MILLER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10535 PARK MEADOWS BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124
Mailing Address - Country:US
Mailing Address - Phone:303-662-8250
Mailing Address - Fax:303-662-8249
Practice Address - Street 1:10535 PARK MEADOWS BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:303-662-8250
Practice Address - Fax:303-662-8249
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA 570363A00000X
COPA.0006361363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5II96OtherABCBS
ARPA 570OtherAR MEDICAL LICENSE