Provider Demographics
NPI:1124028428
Name:MILLER, EDMUND E (MD)
Entity type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:E
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:610 STATE FARM RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4738
Mailing Address - Country:US
Mailing Address - Phone:828-264-0042
Mailing Address - Fax:828-264-8612
Practice Address - Street 1:610 STATE FARM RD
Practice Address - Street 2:SUITE A
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4738
Practice Address - Country:US
Practice Address - Phone:828-264-0042
Practice Address - Fax:828-264-8612
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC22596207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8958907Medicaid
2074256OtherFIRST HEALTH
TN4172879Medicaid
TN3058058OtherBCBS TN
12160OtherPARTNERS
NC53862OtherMEDCOST
NC58907OtherBCBS NC
2074256OtherFIRST HEALTH
12160OtherPARTNERS