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Individual

DR. JOHNATHAN CHANCE MILLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
7122 NASHVILLE AVE, SAINT LOUIS, MO 63117-2337
(314) 329-8109
(314) 350-0231
Mailing address
7122 NASHVILLE AVE, SAINT LOUIS, MO 63117-2337
(314) 329-8109
(314) 350-0231

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
2020035594
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
101074
GA LICENSE
GA
01
101277587
VA LICENSE
VA
01
1013323
MA LICENSE
MA
01
12314722-1205
UT LICENSE
UT
01
2020035594
MO LICENSE
MO
01
2024-00059
NC LICENSE
NC
01
25MA11832200
NJ LICENSE
NJ
01
31324
MS LICENSE
MS
01
319711
NY LICENSE
NY
01
31996
WV LICENSE
WV
01
334502
LA LICENSE
LA
01
35.141126
OH LICENSE
OH
01
36156953
IL LICENSE
IL
01
37701
OK LICENSE
OK
01
4301508656
MI LICENSE
MI
01
70912
AZ LICENSE
AZ
01
75961
MN LICENSE
MN
01
D91957
MD LICENSE
MD
01
E-15164
AR LICENSE
AR
01
MD-50615
IA LICENSE
IA
01
MD.45970
AL LICENSE
AL
01
MD474783
PA LICENSE
PA
01
ME165293
FL LICENSE
FL
01
MED-PHYS-LIC-116474
MT LICENSE
MT
01
U7016
TX LICENSE
TX
Enumeration date
06/21/2018
Last updated
08/01/2024
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