Individual
MR. DAVID L MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7400 MENAUL BLVD NE, ALBUQUERQUE, NM 87110-3636
(505) 552-5300
(505) 552-5490
Mailing address
PO BOX 130, SAN FIDEL, NM 87049-0130
(505) 552-5300
(505) 552-5490
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
PA03057
TX
363A00000X
Physician Assistant
Primary
PA2015-0004
NM
363AM0700X
Medical Physician Assistant
PA.200433
LA
363AM0700X
Medical Physician Assistant
PA03057
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
H3451
—
NM
01
—
PA 2015-0004
PA LICENSE
NM
01
—
PA.200433
LOUISIANA BOARD OF MEDICAL EXAMINERS
LA
01
—
PA03057
TEXAS BOARD OF MEDICAL EXAMINERS
TX
Enumeration date
08/23/2006
Last updated
07/09/2024
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