Provider Demographics
NPI:1336208313
Name:MILLER, BRUCE PAUL (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:PAUL
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:PO BOX 507
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:OH
Mailing Address - Zip Code:43080-0507
Mailing Address - Country:US
Mailing Address - Phone:740-892-2171
Mailing Address - Fax:740-892-4961
Practice Address - Street 1:248 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:OH
Practice Address - Zip Code:43080-0507
Practice Address - Country:US
Practice Address - Phone:740-892-2171
Practice Address - Fax:740-892-4961
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047518207R00000X
KY21683207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311047177001OtherMEDICAL MUTUAL
OH0511486Medicaid
0400520OtherUNITED HEALTHCARE
000000115582OtherANTHEM BCBS
OH0511486Medicaid
0400520OtherUNITED HEALTHCARE