Provider Demographics
NPI:1750964250
Name:MILLER, JOSEPH HARMON (PA-C)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:HARMON
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 1:1330 NE 136TH AVE APT 42
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5916
Mailing Address - Country:US
Mailing Address - Phone:651-324-5009
Mailing Address - Fax:
Practice Address - Street 1:1515 NW 18TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2539
Practice Address - Country:US
Practice Address - Phone:503-224-8399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA203438363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical