Provider Demographics
NPI:1922436781
Name:MILLER, CHARLES
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2262
Mailing Address - Street 2:
Mailing Address - City:DOT LAKE
Mailing Address - State:AK
Mailing Address - Zip Code:99737
Mailing Address - Country:US
Mailing Address - Phone:907-882-2737
Mailing Address - Fax:907-882-2774
Practice Address - Street 1:CHARLES ST.
Practice Address - Street 2:
Practice Address - City:DOT LAKE
Practice Address - State:AK
Practice Address - Zip Code:99737
Practice Address - Country:US
Practice Address - Phone:907-882-2737
Practice Address - Fax:907-882-2774
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker