Provider Demographics
NPI:1770592701
Name:MILLER, JOHN LEE (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LEE
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 1:8510 BRYANT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-3845
Mailing Address - Country:US
Mailing Address - Phone:303-430-5560
Mailing Address - Fax:303-430-5565
Practice Address - Street 1:8510 BRYANT ST STE 200
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3845
Practice Address - Country:US
Practice Address - Phone:303-430-5560
Practice Address - Fax:303-430-5565
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19025207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01190255Medicaid
D23539Medicare UPIN
C302138Medicare ID - Type Unspecified