Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | O-1148 | ID |
N | 207XS0106X | Orthopaedic Hand Surgeon | O-1148 | ID |
NPI | 1073877213 |
---|---|
Provider Name | Dr. Ryan Ned Miller |
First Address | Pocatello, ID 83201-2717 |
Second Address | Pocatello, ID 83201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2012 |
Last Update Date | 06/12/2019 |