Provider Demographics
NPI:1699704916
Name:MILLER, WILLIAM D (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:D
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:305 KEENE ST
Practice Address - Street 2:STE. 203
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6897
Practice Address - Country:US
Practice Address - Phone:573-882-8000
Practice Address - Fax:573-882-6600
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2A82207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208688OtherBLUE CHOICE
MO193109OtherHEALTHLINK
MO193109OtherHEALTHLINK
MOE07761Medicare UPIN
MOP00430575Medicare PIN