Provider Demographics
NPI:1477794451
Name:MILLER, PRESTON DAVID (PA-C)
Entity type:Individual
Prefix:
First Name:PRESTON
Middle Name:DAVID
Last Name:MILLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 W PINE DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7516
Mailing Address - Country:US
Mailing Address - Phone:602-614-9094
Mailing Address - Fax:
Practice Address - Street 1:3051 N WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2248
Practice Address - Country:US
Practice Address - Phone:928-772-2591
Practice Address - Fax:928-772-1148
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1257363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical