Provider Demographics
NPI:1407810575
Name:MILLER, JOHN CARLYLE (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CARLYLE
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 ESCALANTE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-8934
Mailing Address - Country:US
Mailing Address - Phone:970-259-5303
Mailing Address - Fax:970-259-3510
Practice Address - Street 1:1266 ESCALANTE DR STE 201
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-8934
Practice Address - Country:US
Practice Address - Phone:970-259-5303
Practice Address - Fax:970-259-3510
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM467213ES0103X
ND48213ES0103X
CO0000909213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND00112001OtherBCBSND
ND11968Medicaid
ND00112001OtherBCBSND
NDU91203Medicare UPIN