Provider Demographics
NPI:1851377634
Name:MILLER, JOHN LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LESLIE
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12021 211TH PL SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-3944
Mailing Address - Country:US
Mailing Address - Phone:360-668-3515
Mailing Address - Fax:
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER, ATTN:MCHJ-HOM
Practice Address - Street 2:9040-A FITZSIMMONS AVE
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-3408
Practice Address - Fax:253-968-5572
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000146562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AM6727753OtherDEA