Provider Demographics
NPI:1770582025
Name:MILLER, MINDY LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:MINDY
Middle Name:LYNN
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 1:236 S 3RD ST # 328
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3618
Mailing Address - Country:US
Mailing Address - Phone:970-367-1414
Mailing Address - Fax:970-572-9641
Practice Address - Street 1:19540 6565 ROAD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81403
Practice Address - Country:US
Practice Address - Phone:970-367-1414
Practice Address - Fax:970-572-9641
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2022-12-19
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-21
Provider Licenses
StateLicense IDTaxonomies
CO36118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO640571OtherBLUE CROSS BLUE SHIELD
CO345777751Medicaid
COG53547Medicare UPIN
CO454798Medicare ID - Type UnspecifiedGROUP MEDICARE
CO640571OtherBLUE CROSS BLUE SHIELD