Provider Demographics
NPI:1023056850
Name:MILLER, DONALD (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2241 WANKEL WAY STE A
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-0191
Mailing Address - Country:US
Mailing Address - Phone:805-983-0521
Mailing Address - Fax:805-919-2684
Practice Address - Street 1:2241 WANKEL WAY STE A
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030
Practice Address - Country:US
Practice Address - Phone:805-983-0521
Practice Address - Fax:805-919-2684
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043497L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA110119969OtherRAILROAD
PA1427468Medicaid
PA732636LDDMedicare PIN
PAF51245Medicare UPIN