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Individual
DR. LAWRENCE GORDON MILLER III
Active
Individual
DR. LAWRENCE GORDON MILLER III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
0101032522
VA
207V00000X
Obstetrics & Gynecology Physician
Primary
0101032522
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006205917
—
VA
01
—
045806
ANTHEM BLUECROSS BLUESHIE
VA
01
—
24848
MDIPA
VA
01
—
501270
AETNA
VA
01
—
541421810
TAX ID
VA
Enumeration date
07/24/2006
Last updated
10/17/2017
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