Provider Demographics
NPI:1447530142
Name:JEFFREY D. MILLER, MD, P.C.
Entity type:Organization
Organization Name:JEFFREY D. MILLER, MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-220-2981
Mailing Address - Street 1:6727 ACADEMY RD NE STE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3369
Mailing Address - Country:US
Mailing Address - Phone:505-292-1818
Mailing Address - Fax:505-293-2952
Practice Address - Street 1:6727 ACADEMY RD NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3369
Practice Address - Country:US
Practice Address - Phone:505-292-1818
Practice Address - Fax:505-293-2952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMFA0099744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty