Active NPI
Lon Miller, MD
- Emergency Medicine Physician
- Glendale, AZ
National Provider Identifier
1760406771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- M6077
- Practice address
- 4120 W Soft Wind Dr
Glendale, AZ 85310-4000 - Phone
- (509) 336-3775
- Fax
- (623) 547-7196
- NPI assigned
- Jul 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | M6077 | ID | Primary |
| Emergency Medicine Physician | 207P00000X | MD00030099 | WA |
Addresses
Primary practice location
4120 W Soft Wind Dr
Glendale, AZ 85310-4000
Mailing address
4120 W Soft Wind Dr
Glendale, AZ 85310-4000
Phone (509) 336-3775
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8167116 | Medicaid | WA | |
| 003836400 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319673600000",
"number": "1760406771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4120 W SOFT WIND DR",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853104000",
"telephone_number": "509-336-3775",
"fax_number": "623-547-7196"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4120 W SOFT WIND DR",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853104000",
"telephone_number": "509-336-3775",
"fax_number": "623-547-7196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "LON",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2011-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "ID",
"license": "M6077",
"primary": true
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "WA",
"license": "MD00030099",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8167116",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003836400",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.