Provider Demographics
NPI:1902887524
Name:MILLER, MARTHA R (MD)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 E ERICKSON
Mailing Address - Street 2:#120
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:520-382-6506
Mailing Address - Fax:520-382-6509
Practice Address - Street 1:5300 E ERICKSON
Practice Address - Street 2:#120
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712
Practice Address - Country:US
Practice Address - Phone:520-382-6506
Practice Address - Fax:520-382-6509
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25610207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ400664Medicaid
AZ81958Medicare ID - Type Unspecified
AZG58849Medicare UPIN