Provider Demographics
NPI:1497764195
Name:MILLER, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1906 BLAKE AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4227
Mailing Address - Country:US
Mailing Address - Phone:970-384-6770
Mailing Address - Fax:970-384-6765
Practice Address - Street 1:1906 BLAKE AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4227
Practice Address - Country:US
Practice Address - Phone:970-384-6770
Practice Address - Fax:970-384-6765
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2013-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO38595207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO31774016Medicaid
CO31774016Medicaid
COG07390Medicare UPIN
COCO3000362Medicare Oscar/Certification