Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD187656 | OR |
N | 111NI0900X | Internist | MD187656 | OR |
N | 207RC0000X | Internist - Cardiovascular Disease | MD187656 | OR |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | MD187656 | OR |
NPI | 1013293620 |
---|---|
Provider Name | Dr. Jared David Miller |
First Address | Salt Lake City, UT 84107-5701 |
Second Address | Salt Lake City, UT 84107-5701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2011 |
Last Update Date | 14/01/2020 |