Provider Demographics
NPI:1801082102
Name:MILLER, GARTH A (MD)
Entity type:Individual
Prefix:
First Name:GARTH
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
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:PO BOX 3603
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3603
Mailing Address - Country:US
Mailing Address - Phone:360-678-7656
Mailing Address - Fax:866-442-8884
Practice Address - Street 1:101 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3413
Practice Address - Country:US
Practice Address - Phone:360-678-7656
Practice Address - Fax:360-678-7676
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013198207RG0100X, 208600000X, 208C00000X
WA00018695208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2087258Medicaid
ME128090000Medicaid
MEC91362Medicare UPIN