Basic Information
| Provider Information | |||||||||
| NPI: | 1215974126 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | PEYTON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD FAAP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2925 ALMA HIGHWAY | ||||||||
| Address2: | SUITE C1 | ||||||||
| City: | VAN BUREN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794715454 | ||||||||
| FaxNumber: | 4794715473 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 PENNSYLVANIA AVE | ||||||||
| Address2: | |||||||||
| City: | OTTUMWA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 525016427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6416833448 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 07/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD-42223 | IA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | E1002 | AR | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 129666001 | 05 | AR | MEDICAID |