Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 2005016210 | MO |
N | 207PE0004X | Emergency Medical Services | 2005016210 | MO |
N | 207PE0004X | Emergency Medical Services | OS9768 | FL |
Y | 207Q00000X | Family Doctor | 2005016210 | MO |
NPI | 1003857848 |
---|---|
Provider Name | Dr. Donald Albert Miller |
First Address | Hannibal, MO 63401-1239 |
Second Address | Bowling Green, MO 63334-2803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 01/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1427188 | (05) | MO |
933060024 | (05) | MO |
I41551 | (02) | MO |