Provider Demographics
NPI:1922054626
Name:MILLER, BENJAMIN ADAM (DO)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ADAM
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7808
Mailing Address - Country:US
Mailing Address - Phone:907-796-8700
Mailing Address - Fax:907-796-8710
Practice Address - Street 1:3268 HOSPITAL DR STE A
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7800
Practice Address - Country:US
Practice Address - Phone:907-796-8700
Practice Address - Fax:907-796-8710
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO26618208600000X
AK6434208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1008484Medicaid
OR240380Medicaid
ORR134712Medicare PIN
AK1008484Medicaid
AKP01249307Medicare PIN