Provider Demographics
NPI:1659583367
Name:MILLER, SEAN RAYMOND I (LMP)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:RAYMOND
Last Name:MILLER
Suffix:I
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9228 15TH AVE SW
Mailing Address - Street 2:UNIT C
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106
Mailing Address - Country:US
Mailing Address - Phone:206-280-3559
Mailing Address - Fax:
Practice Address - Street 1:2120 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2027
Practice Address - Country:US
Practice Address - Phone:206-244-7973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016793174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist