Provider Demographics
NPI:1376581157
Name:MILLER, JOHN TRAVIS (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TRAVIS
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:J
Other - Middle Name:TRAVIS
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 830230
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35283-0230
Mailing Address - Country:US
Mailing Address - Phone:205-250-6000
Mailing Address - Fax:205-250-6848
Practice Address - Street 1:6150 US HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:GUIN
Practice Address - State:AL
Practice Address - Zip Code:35563-3529
Practice Address - Country:US
Practice Address - Phone:205-468-2754
Practice Address - Fax:205-468-3664
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009947000Medicaid
ALG63056Medicare UPIN
000099974Medicare PIN