Miller, Brian David

Miller, Brian David is an individual health care provider with primary practice located at 2680 Channing Way , Idaho Falls ID 83404-7517. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Miller, Brian David can be contacted via phone (208) 523-7667.

Contact Information

Primary practice address
2680 Channing Way Idaho Falls ID 83404-7517
Phone: (208) 523-7667
Fax: (208) 523-7668
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA-309 Idaho

Profile Details

NPI number 1861483455
LBN Legal business name Miller, Brian David
Credentials PA-C BS
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 2nd, 2005
Last updated Mar 7th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861483455 NPPES
Other 1041907 PACIFIC SOURCE
MEDICAID 8059104-00 PACIFIC SOURCE
Other PA-309 PACIFIC SOURCE

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