Provider Demographics
NPI:1407269152
Name:MILLER, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-2879
Mailing Address - Country:US
Mailing Address - Phone:417-347-7600
Mailing Address - Fax:
Practice Address - Street 1:3220 WISCONSIN AVE
Practice Address - Street 2:STE D
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4017
Practice Address - Country:US
Practice Address - Phone:417-347-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator