Provider Demographics
NPI:1447256888
Name:MILLER, VERNON WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:VERNON
Middle Name:WALTER
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 1:112 E ARAPAHOE ST
Mailing Address - Street 2:
Mailing Address - City:THERMOPOLIS
Mailing Address - State:WY
Mailing Address - Zip Code:82443-2402
Mailing Address - Country:US
Mailing Address - Phone:307-864-2141
Mailing Address - Fax:307-864-3966
Practice Address - Street 1:112 E ARAPAHOE ST
Practice Address - Street 2:
Practice Address - City:THERMOPOLIS
Practice Address - State:WY
Practice Address - Zip Code:82443-2402
Practice Address - Country:US
Practice Address - Phone:307-864-2141
Practice Address - Fax:307-864-3966
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2962A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106718400Medicaid
WY301369Medicare ID - Type Unspecified
WYA72968Medicare UPIN