Individual
JONATHAN B MILLER
Active
Individual
JONATHAN B MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA01356
OR
363AM0700X
Medical Physician Assistant
PA549
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010149921
REGENCE BLUE SHIELD
ID
05
—
807126000
—
ID
01
—
PA549
PA MEDICAL LICENSE
ID
01
—
PAVQ9
BLUE CROSS OF IDAHO
ID
Enumeration date
06/26/2006
Last updated
01/08/2024
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