Provider Demographics
NPI:1013142850
Name:MILLER, LURA S (DO)
Entity Type:Individual
Prefix:
First Name:LURA
Middle Name:S
Last Name:MILLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 CAMPUS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-9703
Mailing Address - Country:US
Mailing Address - Phone:276-628-1186
Mailing Address - Fax:276-628-8507
Practice Address - Street 1:613 CAMPUS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-9703
Practice Address - Country:US
Practice Address - Phone:276-628-1186
Practice Address - Fax:276-628-8507
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4932207Q00000X
VA0102204194207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1013142850Medicaid
TNQ014838Medicaid
VAVVI612G368Medicare PIN
VA1013142850Medicaid
VAVVI612BMedicare PIN