Provider Demographics
NPI:1871670554
Name:MARTHA R MILLER MD PC
Entity Type:Organization
Organization Name:MARTHA R MILLER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-382-6506
Mailing Address - Street 1:5300 E ERICKSON DR
Mailing Address - Street 2:STE 120
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2828
Mailing Address - Country:US
Mailing Address - Phone:520-382-6506
Mailing Address - Fax:520-382-6509
Practice Address - Street 1:5300 E ERICKSON DR
Practice Address - Street 2:STE 120
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2828
Practice Address - Country:US
Practice Address - Phone:520-382-6506
Practice Address - Fax:520-382-6509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25610207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty