Provider Demographics
NPI:1417917790
Name:MILLER, MARIA NELIDA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:NELIDA
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:MARIA
Other - Middle Name:NELIDA
Other - Last Name:LAGDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:702 JOHN ADAMS
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045
Mailing Address - Country:US
Mailing Address - Phone:503-657-3034
Mailing Address - Fax:503-657-1785
Practice Address - Street 1:702 JOHN ADAMS
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045
Practice Address - Country:US
Practice Address - Phone:503-657-3034
Practice Address - Fax:503-657-1785
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016463207Q00000X
ORMD10275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR2387766Medicaid
C94446Medicare UPIN
OR0000BHHZLMedicare ID - Type Unspecified