Provider Demographics
NPI:1346353778
Name:DONALD R. MILLER, MD
Entity Type:Organization
Organization Name:DONALD R. MILLER, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-426-8398
Mailing Address - Street 1:700 SLEATER KINNEY RD SE STE B
Mailing Address - Street 2:PMB 254
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1113
Mailing Address - Country:US
Mailing Address - Phone:360-426-8398
Mailing Address - Fax:360-426-0413
Practice Address - Street 1:219 PROFESSIONAL WAY
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-4404
Practice Address - Country:US
Practice Address - Phone:360-426-8398
Practice Address - Fax:360-426-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026759208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB13350Medicare ID - Type UnspecifiedMEDICARE
WAE34871Medicare UPIN