Provider Demographics
NPI:1104087469
Name:MILLER, JOHN PHILLIP (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PHILLIP
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 1:1100 RUBY TYLER PKWY
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-2959
Mailing Address - Country:US
Mailing Address - Phone:205-759-2582
Mailing Address - Fax:205-759-2985
Practice Address - Street 1:1100 RUBY TYLER PKWY
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2959
Practice Address - Country:US
Practice Address - Phone:205-759-2582
Practice Address - Fax:205-759-2985
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29942207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL139452Medicaid
ALP01059542OtherRAILROAD MEDICARE
AL102I110530Medicare PIN