Provider Demographics
NPI:1841372620
Name:MILLER, ANTHONY CLARK (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:CLARK
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:REINHARD
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 HIGHWAY 6 W
Mailing Address - Street 2:VA MEDICAL CENTER, MENTAL HEALTH SERVICE LINE, MC 116A
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-2209
Mailing Address - Country:US
Mailing Address - Phone:319-338-0581
Mailing Address - Fax:319-339-7066
Practice Address - Street 1:601 HIGHWAY 6 W
Practice Address - Street 2:VA MEDICAL CENTER, MENTAL HEALTH SERVICE LINE, MC 116A
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-2209
Practice Address - Country:US
Practice Address - Phone:319-338-0581
Practice Address - Fax:319-339-7066
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0147592084P0800X
MO1062492084P0800X
IA375802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM7402Medicare ID - Type Unspecified
G76465Medicare UPIN
IAI0923061Medicare PIN