Provider Demographics
NPI:1740278225
Name:MILLER, BRUCE MILTON (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MILTON
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2202 JOHN B DENNIS HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660
Mailing Address - Country:US
Mailing Address - Phone:423-245-3161
Mailing Address - Fax:423-857-8129
Practice Address - Street 1:2202 JOHN B DENNIS HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660
Practice Address - Country:US
Practice Address - Phone:423-245-3161
Practice Address - Fax:423-857-8129
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD040487207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1740278225Medicaid
TN3336346Medicaid
TNMD040487OtherLICENSE
TNMD040487OtherLICENSE
TN3336346Medicaid