Provider Demographics
NPI:1447280342
Name:MILLER, STANLEY (MD)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4121 E VALLEY AUTO DR
Mailing Address - Street 2:STE 110
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4632
Mailing Address - Country:US
Mailing Address - Phone:602-795-1555
Mailing Address - Fax:602-795-6054
Practice Address - Street 1:926 E MCDOWELL RD
Practice Address - Street 2:SUITE 107
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2503
Practice Address - Country:US
Practice Address - Phone:602-795-1555
Practice Address - Fax:602-795-6054
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2019-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ27653207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZA64799Medicare UPIN