Provider Demographics
NPI:1184603763
Name:MILLER, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
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 1:537 TRIMLEY CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-3865
Mailing Address - Country:US
Mailing Address - Phone:702-456-0710
Mailing Address - Fax:702-456-5315
Practice Address - Street 1:537 TRIMLEY CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-3865
Practice Address - Country:US
Practice Address - Phone:702-456-0710
Practice Address - Fax:702-456-5315
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16988207ZP0102X, 207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ831794Medicaid
AZ77516Medicare ID - Type Unspecified
AZF17368Medicare UPIN