Provider Demographics
NPI:1477588713
Name:MILLER, LOUIS MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:MARK
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LOUIS
Other - Middle Name:MARK
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2160 S DEL VALLE WAY
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6294
Mailing Address - Country:US
Mailing Address - Phone:928-580-0820
Mailing Address - Fax:928-344-1133
Practice Address - Street 1:2160 S DEL VALLE WAY
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6294
Practice Address - Country:US
Practice Address - Phone:928-580-0820
Practice Address - Fax:928-344-1133
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ232012086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ189565OtherAHCCCS
AZ22771Medicare ID - Type Unspecified
AZE-51843Medicare UPIN