Dr Gerald W Miller MD PC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

MD16819 Issued in OR

Legal business name

DR GERALD W MILLER MD PC

Practice address

1960 NW 167TH PL
Suite 103
Beaverton, OR 97006-4803

Phone

(503) 466-1823

Fax

(503) 466-2045

NPI assigned

Nov 4, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gerald Wendall Miller, MD

Title

Ceo

Phone

(503) 466-1823

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1257292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257292800000",
    "number": "1386971836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1960 NW 167TH PL",
            "address_2": "SUITE 103",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970064803",
            "telephone_number": "503-466-1823",
            "fax_number": "503-466-2045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1960 NW 167TH PL",
            "address_2": "SUITE 103",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970064803",
            "telephone_number": "503-466-1823",
            "fax_number": "503-466-2045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR GERALD W MILLER MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-04",
        "last_updated": "2009-11-04",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "WENDALL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "503-466-1823",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "OR",
            "license": "MD16819",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8140758",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "021977",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.