Provider Demographics
NPI:1760810022
Name:MILLER, ANTHONY M
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:M
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-2725
Mailing Address - Country:US
Mailing Address - Phone:310-591-0123
Mailing Address - Fax:
Practice Address - Street 1:659 AVENUE H
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-2725
Practice Address - Country:US
Practice Address - Phone:310-591-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker