Provider Demographics
NPI:1497788376
Name:MILLER, GARY JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:JAMES
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6401 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4341
Mailing Address - Country:US
Mailing Address - Phone:763-572-5710
Mailing Address - Fax:763-571-3008
Practice Address - Street 1:10000 ZANE AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1400
Practice Address - Country:US
Practice Address - Phone:763-572-5710
Practice Address - Fax:763-569-6200
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN19788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN21448OtherAMERICA'S PPO
MNHP19901OtherHEALTHPARTNERS
MN1000882OtherPREFERRED ONE
MN0108809OtherMEDICA #
MN106429OtherUCARE MN #
MN6603844OtherMEDICA UC #
MN11602MIOtherBCBS OF MN
MN4044539OtherAETNA INS
MNHP19901OtherHEALTHPARTNERS