Provider Demographics
NPI:1518936913
Name:MILLER, WILLIAM SMITH (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SMITH
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 1:201 S PRESTON ST STE A
Mailing Address - Street 2:
Mailing Address - City:RANSON
Mailing Address - State:WV
Mailing Address - Zip Code:25438-1675
Mailing Address - Country:US
Mailing Address - Phone:304-725-6514
Mailing Address - Fax:
Practice Address - Street 1:201 S PRESTON ST STE A
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-1675
Practice Address - Country:US
Practice Address - Phone:304-725-6514
Practice Address - Fax:304-725-3781
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
410113203OtherRR MEDICARE
WV001721157OtherMTN STATE BC/BS
WV0489491OtherPTAN
WV822511OtherMAMSI IDENTIFICATION
WV0056320000Medicaid
WV822511OtherMAMSI IDENTIFICATION