Provider Demographics
NPI:1053568592
Name:MILLER, GARRY TIM II (DO)
Entity type:Individual
Prefix:DR
First Name:GARRY
Middle Name:TIM
Last Name:MILLER
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:555 W SR 164 NORTH
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:UT
Practice Address - Zip Code:84653-1666
Practice Address - Country:US
Practice Address - Phone:801-465-4813
Practice Address - Fax:801-812-5433
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101017699207R00000X
UT7929795-1204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine