Provider Demographics
NPI:1841365756
Name:MILLER, BRYAN ALAN
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:ALAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BRYAN
Other - Middle Name:ALAN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:1400 E BOULDER ST
Mailing Address - Street 2:ATTN: KATHY KAUP - EMS
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5533
Mailing Address - Country:US
Mailing Address - Phone:719-365-2001
Mailing Address - Fax:719-365-2009
Practice Address - Street 1:1400 E BOULDER ST
Practice Address - Street 2:ATTN: KATHY KAUP - EMS
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5533
Practice Address - Country:US
Practice Address - Phone:719-365-2001
Practice Address - Fax:719-365-2009
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA0003540363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant