Provider Demographics
NPI:1275576621
Name:MILLER, DONALD REX (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:REX
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 SLEATER KINNEY RD SE
Mailing Address - Street 2:PMB 254
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1113
Mailing Address - Country:US
Mailing Address - Phone:360-426-8398
Mailing Address - Fax:360-426-0413
Practice Address - Street 1:1299 BISHOP RD
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-8758
Practice Address - Country:US
Practice Address - Phone:360-740-4001
Practice Address - Fax:360-740-4170
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00026759208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1280270Medicaid
WAE34871Medicare UPIN
WAGAB13350Medicare ID - Type UnspecifiedMEDICARE ID NUMBER