Provider Demographics
NPI:1780688523
Name:MILLER, ROGER W (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:W
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2095 EXCHANGE ST
Mailing Address - Street 2:SUITE #201
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3417
Mailing Address - Country:US
Mailing Address - Phone:503-338-4455
Mailing Address - Fax:503-338-4837
Practice Address - Street 1:2095 EXCHANGE ST
Practice Address - Street 2:SUITE #201
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3417
Practice Address - Country:US
Practice Address - Phone:503-338-4455
Practice Address - Fax:503-338-4837
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD24790207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1119841Medicaid
OR233147Medicaid
OR233147Medicaid
ORR118178Medicare PIN