Provider Demographics
NPI:1255334637
Name:MILLER, ANNE ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:ELIZABETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4021
Mailing Address - Country:US
Mailing Address - Phone:307-634-2020
Mailing Address - Fax:307-635-6510
Practice Address - Street 1:1300 E 20TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4021
Practice Address - Country:US
Practice Address - Phone:307-634-2020
Practice Address - Fax:307-635-6510
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6531A207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY116087700Medicaid
310795Medicare ID - Type Unspecified
H32043Medicare UPIN