Provider Demographics
NPI:1013906049
Name:MILLER, WARREN N (MD)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:N
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:217 W GEORGIA AVE
Mailing Address - Street 2:STE 115
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6811
Mailing Address - Country:US
Mailing Address - Phone:208-463-3234
Mailing Address - Fax:208-463-3044
Practice Address - Street 1:4400 E FLAMINGO AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-9203
Practice Address - Country:US
Practice Address - Phone:208-288-4970
Practice Address - Fax:208-463-3044
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM3815207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002365600Medicaid
ID000010005751OtherBLUE SHIELD
ID000010138751OtherBLUE SHIELD
ID070004831OtherRAILROAD MEDICARE
ID38158OtherBLUE CROSS
ID28634OtherBLUE CROSS
ID000010138751OtherBLUE SHIELD