Provider Demographics
NPI:1336319243
Name:MILLER, BRIAN (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 DEBARR RD
Mailing Address - Street 2:SUITE C-411
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2961
Mailing Address - Country:US
Mailing Address - Phone:907-222-2739
Mailing Address - Fax:907-222-2746
Practice Address - Street 1:2741 DEBARR RD
Practice Address - Street 2:SUITE C-411
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2961
Practice Address - Country:US
Practice Address - Phone:907-222-2739
Practice Address - Fax:907-222-2746
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7834207T00000X, 207T00000X
MDH74671207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1627141Medicaid
MD056587300Medicaid