Provider Demographics
NPI:1124491212
Name:MILLER, DEREK STEVEN (MMS, PA-C)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:STEVEN
Last Name:MILLER
Suffix:
Gender:M
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S JACKSON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3176
Mailing Address - Country:US
Mailing Address - Phone:303-321-0222
Mailing Address - Fax:303-321-6683
Practice Address - Street 1:300 S JACKSON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3176
Practice Address - Country:US
Practice Address - Phone:303-321-0222
Practice Address - Fax:303-321-6683
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004448363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0004448OtherPHYSICIAN ASSISTANT COLORADO LICENSE