Provider Demographics
NPI:1285703728
Name:MILLER, GLENN GILBB (MD)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:GILBB
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:75 PRINGLE WAY
Mailing Address - Street 2:SUITE 906
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502
Mailing Address - Country:US
Mailing Address - Phone:775-852-7773
Mailing Address - Fax:775-982-6271
Practice Address - Street 1:75 PRINGLE WAY
Practice Address - Street 2:SUITE 906
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502
Practice Address - Country:US
Practice Address - Phone:775-852-7773
Practice Address - Fax:775-982-6271
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2013-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV5353207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A36134Medicare UPIN
V39584Medicare PIN
NVA36134Medicare UPIN