Provider Demographics
NPI:1194726810
Name:MILLER, BRYAN D (DO)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:D
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 S 1ST AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-3982
Mailing Address - Country:US
Mailing Address - Phone:503-648-8210
Mailing Address - Fax:503-648-8283
Practice Address - Street 1:434 S 1ST AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-3982
Practice Address - Country:US
Practice Address - Phone:503-648-8210
Practice Address - Fax:503-648-8283
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18724207Q00000X, 208D00000X, 2083A0100X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR129999Medicaid
OR129999Medicaid
FLF49337Medicare UPIN