Provider Demographics
NPI:1386971836
Name:DR GERALD W MILLER MD PC
Entity type:Organization
Organization Name:DR GERALD W MILLER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:WENDALL
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-466-1823
Mailing Address - Street 1:1960 NW 167TH PL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4803
Mailing Address - Country:US
Mailing Address - Phone:503-466-1823
Mailing Address - Fax:503-466-2045
Practice Address - Street 1:1960 NW 167TH PL
Practice Address - Street 2:SUITE 103
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4803
Practice Address - Country:US
Practice Address - Phone:503-466-1823
Practice Address - Fax:503-466-2045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16819261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8140758Medicaid
OR021977Medicaid
ORF02994Medicare UPIN
WA000680610Medicare PIN
OR021977Medicaid