Provider Demographics
NPI:1073653663
Name:MILLER, JAMES JASON (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:JASON
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SHELBY STATION DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-4186
Mailing Address - Country:US
Mailing Address - Phone:502-254-0009
Mailing Address - Fax:502-753-6460
Practice Address - Street 1:300 SHELBY STATION DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-4186
Practice Address - Country:US
Practice Address - Phone:502-254-0009
Practice Address - Fax:502-753-6460
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40667208100000X
IN01059429A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000516482OtherANTHEM - NREHABPHYS
IN200871920Medicaid
INP00450883OtherRAILROAD MEDICARE
086082OtherSIHO - NREHABPHYS
KY7100027220Medicaid
IN196290JJJMedicare PIN
086082OtherSIHO - NREHABPHYS
000000516482OtherANTHEM - NREHABPHYS
IN200871920Medicaid