Provider Demographics
NPI:1619084415
Name:MILLER, CHRISTOPHER RAY (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:RAY
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 1:3164 S 3075 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-2147
Mailing Address - Country:US
Mailing Address - Phone:801-487-4252
Mailing Address - Fax:
Practice Address - Street 1:100 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-993-9551
Practice Address - Fax:801-733-5872
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT377570-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY119182900Medicaid
MT0153238Medicaid
UT301OtherHEALTHY U
UT741242OtherDESERET MUTUAL
UTQM0000066426OtherALTIUS
UT100502368OtherFIRST HEALTH
UT870280408CMPOtherEDUCATORS MUTUAL
UTPRA07085OtherMOLINA
UT107011794102OtherIHC
UT37757012001001OtherBCBS
ID806645300Medicaid
UT73344OtherPEHP
AZ837958Medicaid
UT301OtherHEALTHY U