Provider Demographics
NPI:1629266374
Name:DAVID S MILLER MD
Entity Type:Organization
Organization Name:DAVID S MILLER MD
Other - Org Name:PEDIATRIC CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-341-3717
Mailing Address - Street 1:995 WILLAGILLESPIE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2170
Mailing Address - Country:US
Mailing Address - Phone:541-341-3717
Mailing Address - Fax:541-302-8107
Practice Address - Street 1:995 WILLAGILLESPIE RD
Practice Address - Street 2:STE 200
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2170
Practice Address - Country:US
Practice Address - Phone:541-341-3717
Practice Address - Fax:541-302-8107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD12022208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR013532Medicaid