Individual
DERRYL JOSEPH MILLER
Active
Individual
DERRYL JOSEPH MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084E0001X
Epilepsy Physician
01084560A
IN
2084N0400X
Neurology Physician
Primary
01084560A
IN
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
01084560A
IN
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
ME178109
FL
2084N0600X
Clinical Neurophysiology Physician
01084560A
IN
2084N0600X
Clinical Neurophysiology Physician
110363
GA
2084N0600X
Clinical Neurophysiology Physician
MD492940C
PA
390200000X
Student in an Organized Health Care Education/Training Program
11018132A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001556252
ANTHEM PTAN
IN
01
—
0002097705
INDIANA UNIVERSITY SCHOOL OF MEDICINE EMPLOYEE ID
IN
01
—
11018132A
INDIANA PROFESSIONAL LICENSING AGENCY
IN
05
—
201292800
—
IN
Enumeration date
05/15/2015
Last updated
06/25/2026
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