Basic Information
| Provider Information | |||||||||
| NPI: | 1760428734 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3126 N CIVIC CENTER PLZ | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852516912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808742040 | ||||||||
| FaxNumber: | 4808742041 | ||||||||
| Practice Location | |||||||||
| Address1: | 3126 N CIVIC CENTER PLZ | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852516912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808742040 | ||||||||
| FaxNumber: | 4808742041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 10/21/2011 | ||||||||
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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 | 207X00000X | A94284 | CA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | AZ37139 | AZ | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 233689 | 05 | AZ | MEDICAID |