Provider Demographics
NPI:1134566268
Name:MILLER, JUSTIN ALAN (MD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ALAN
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 1:5115 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-7018
Mailing Address - Country:US
Mailing Address - Phone:910-362-1011
Mailing Address - Fax:910-362-1012
Practice Address - Street 1:5115 OLEANDER DR RM 8549
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7018
Practice Address - Country:US
Practice Address - Phone:910-362-1011
Practice Address - Fax:910-362-1012
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA306418207R00000X
NC255763207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00587042Medicaid