Individual
JEFFREY R MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1305 N ELM ST, HENDERSON, KY 42420-2783
(812) 485-4415
(812) 471-6650
Mailing address
PO BOX 436, HENDERSON, KY 42419-0436
(812) 471-1591
(812) 471-6650
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01052478A
IN
2085R0202X
Diagnostic Radiology Physician
32709
KY
2085R0204X
Vascular & Interventional Radiology Physician
01052478A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000546001
ANTHEM BC/BS
KY
05
—
200278130
—
IN
05
—
64012107
—
KY
01
—
P00476263
RAIL ROAD MEDICARE
KY
Enumeration date
09/19/2005
Last updated
09/28/2020
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