Provider Demographics
NPI:1346531506
Name:MILLER, BRIAN ALAN (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ALAN
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 1:2255 CANDLEGLOW ST
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3562
Mailing Address - Country:US
Mailing Address - Phone:719-457-6200
Mailing Address - Fax:
Practice Address - Street 1:1001 W MINERAL AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4507
Practice Address - Country:US
Practice Address - Phone:719-457-6200
Practice Address - Fax:303-363-5142
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0055213208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00175048Medicaid