Provider Demographics
NPI:1396159125
Name:MILLER, DAISY L (DO)
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DAISY
Other - Middle Name:L
Other - Last Name:WINTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1441 NE 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-5420
Mailing Address - Country:US
Mailing Address - Phone:208-642-9376
Mailing Address - Fax:208-642-9598
Practice Address - Street 1:1219 SW 4TH AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-4500
Practice Address - Country:US
Practice Address - Phone:541-881-2800
Practice Address - Fax:541-881-2825
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004866A207Q00000X
IN11017941A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine