Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | CH00002256 | WA |
Y | 213ER0200X | Radiology | CH00002256 | WA |
NPI | 1831250109 |
---|---|
Provider Name | John Stephen Miller |
First Address | Seattle, WA 98117-3481 |
Second Address | Seattle, WA 98117-3481 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 08/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0004396929 | AETNA INSURANCE COMPANY (01) | WA |
MI8798 | REGENCE BLUESHIELD (01) | WA |