Provider Demographics
NPI:1255566196
Name:MILLER, BRIAN K (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 MEDICAL PARK DR
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-1100
Mailing Address - Country:US
Mailing Address - Phone:423-302-6882
Mailing Address - Fax:423-952-2147
Practice Address - Street 1:245 MEDICAL PARK DR
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-1100
Practice Address - Country:US
Practice Address - Phone:276-378-1341
Practice Address - Fax:276-378-1345
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4931207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1255566196Medicaid
VA1255566196Medicaid