Provider Demographics
NPI:1689688723
Name:MILLER, RUSSELL LOYD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:LOYD
Last Name:MILLER
Suffix:JR
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 1:1605 N PORTAL DR NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1012
Mailing Address - Country:US
Mailing Address - Phone:202-723-5213
Mailing Address - Fax:
Practice Address - Street 1:1605 N PORTAL DR NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1012
Practice Address - Country:US
Practice Address - Phone:202-723-5213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD3806207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine