Provider Demographics
NPI:1407990161
Name:MILLER, ARLO J (MD)
Entity Type:Individual
Prefix:
First Name:ARLO
Middle Name:J
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 NW GILMAN BLVD
Mailing Address - Street 2:SUITE 301A
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2483
Mailing Address - Country:US
Mailing Address - Phone:425-654-1275
Mailing Address - Fax:425-654-0539
Practice Address - Street 1:450 NW GILMAN BLVD
Practice Address - Street 2:SUITE 301A
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2483
Practice Address - Country:US
Practice Address - Phone:425-654-1275
Practice Address - Fax:425-654-0539
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60173899207ND0101X, 207ND0900X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8894457Medicare PIN