Provider Demographics
NPI:1255344669
Name:LYNCH MILLER, ALISON (MD)
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:
Last Name:LYNCH 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 1:25 NW LOUISIANA
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:541-388-8253
Mailing Address - Fax:541-617-0894
Practice Address - Street 1:25 NW LOUISIANA
Practice Address - Street 2:SUITE 100
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701
Practice Address - Country:US
Practice Address - Phone:541-388-8253
Practice Address - Fax:541-617-0894
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17286207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR066659Medicaid
114351/114350Medicare ID - Type Unspecified
OR066659Medicaid