Provider Demographics
NPI:1891991717
Name:MILLER, SETH B (MD)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:B
Last Name:MILLER
Suffix:
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 1:1390 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4430
Mailing Address - Country:US
Mailing Address - Phone:928-344-4325
Mailing Address - Fax:928-344-3084
Practice Address - Street 1:1390 W 16TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4430
Practice Address - Country:US
Practice Address - Phone:928-344-4325
Practice Address - Fax:928-344-3084
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ76499390200000X
AZ42979207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ139299Medicare PIN