Active NPI
Fred P Miller, FNP
- Family Medicine Physician
- Gooding, ID
National Provider Identifier
1598720997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- NP104
- Practice address
- 425 Idaho Street
Gooding, ID 83330 - Phone
- (208) 934-5900
- Fax
- (208) 934-5719
- NPI assigned
- Apr 19, 2006
- Last updated
- Mar 5, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | NP104 | ID | Primary |
Addresses
Primary practice location
425 Idaho Street
Gooding, ID 83330
Mailing address
PO Box 447
Gooding, ID 83330
Phone (208) 934-5900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP104 | ID | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1520208000000",
"number": "1598720997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 447",
"city": "GOODING",
"state": "ID",
"postal_code": "83330",
"telephone_number": "208-934-5900",
"fax_number": "208-934-5719"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 IDAHO STREET",
"city": "GOODING",
"state": "ID",
"postal_code": "83330",
"telephone_number": "208-934-5900",
"fax_number": "208-934-5719"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "FRED",
"middle_name": "P",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-19",
"last_updated": "2018-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ID",
"license": "NP104",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gooding, ID
- Mark C. Lambert, DMD PC (Gooding Family and Cosmetic Dentistry)
- John Mason, BA, CADC
- Amanda Marie McCrorey, SUDA
- Tyler McOmber, OTR/L
- Francisca O Mendez
- Marcy Lin Morrow, PAC
- Tyler Dawn Moulton, LCSW
- Aime Clarice Muntz, LMSW
- Dean Allan Nelson, DO
- North Canyon Medical Center Inc. (North Canyon Medical Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.