Individual
BRIAN DAVID MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C BS
Contact information
Practice address
2680 CHANNING WAY, IDAHO FALLS, ID 83404-7517
(208) 523-7667
(208) 523-7668
Mailing address
2680 CHANNING WAY, IDAHO FALLS, ID 83404-7517
(208) 523-7667
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-309
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1041907
PACIFIC SOURCE
—
05
—
8059104-00
—
ID
01
—
PA-309
ID STATE LISC
ID
Enumeration date
11/02/2005
Last updated
03/07/2023
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