Basic Information
| Provider Information | |||||||||
| NPI: | 1538194410 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 369 | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286400369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368467433 | ||||||||
| FaxNumber: | 3368467878 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 HOSPITAL AVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | JEFFERSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286409244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368467433 | ||||||||
| FaxNumber: | 3368467878 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 73501 | NC | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 0173A | 01 | NC | BCBS | OTHER | 8958904 | 05 | NC | MEDICAID |