Provider Demographics
NPI:1902875701
Name:MILLER, PAMELA CHRISTINE (DO)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:CHRISTINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:CHRISTINE
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3240 COUNTY ROAD 645
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-9567
Mailing Address - Country:US
Mailing Address - Phone:573-803-0146
Mailing Address - Fax:
Practice Address - Street 1:211 SAINT FRANCIS DRIVE
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703
Practice Address - Country:US
Practice Address - Phone:573-331-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7639207P00000X
IA3888207P00000X
MO2011000240207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1902875701Medicaid
IA1902875701OtherBLUE SHIELD
IA1902875701Medicaid