Individual
JEFFREY WELLS MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 E KINCAID ST, MOUNT VERNON, WA 98274-4127
(360) 814-6315
(360) 814-6261
Mailing address
1400 E KINCAID ST, ATTN: CREDENTIALING, MOUNT VERNON, WA 98274-4127
(360) 428-2500
(360) 428-6485
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD60394795
WA
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
MD60394795
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487088738
—
WA
01
—
P01336664
RR MEDICARE
WA
Enumeration date
08/22/2013
Last updated
10/13/2016
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