Provider Demographics
NPI:1780877191
Name:MILLER, TODD (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MILLER
Other - Middle Name:MEDICAL
Other - Last Name:INC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MILLER MEDICAL INC
Mailing Address - Street 1:57 N 775 E
Mailing Address - Street 2:
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337-4103
Mailing Address - Country:US
Mailing Address - Phone:435-915-6262
Mailing Address - Fax:435-201-8200
Practice Address - Street 1:57 N 775 E
Practice Address - Street 2:
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337-4103
Practice Address - Country:US
Practice Address - Phone:435-915-6262
Practice Address - Fax:435-201-8200
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6681778-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000063422Medicare PIN