Provider Demographics
NPI:1922367242
Name:MILLER, ALISA ANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:ANNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3117 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4518
Mailing Address - Country:US
Mailing Address - Phone:210-292-7805
Mailing Address - Fax:210-292-7868
Practice Address - Street 1:2200 BERGQUIST DR.
Practice Address - Street 2:WILFORD HALL AMB SURGICAL CENTER
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236-9908
Practice Address - Country:US
Practice Address - Phone:210-292-7805
Practice Address - Fax:210-292-7868
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2019-08-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0102203712208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice