Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G29102 | CA |
N | 207ND0900X | Dermatopathologist | G29102 | CA |
N | 207NS0135X | Procedural Dermatology | G29102 | CA |
NPI | 1134224751 |
---|---|
Provider Name | Bruce Dean Miller |
First Address | Placerville, CA 95667-5746 |
Second Address | Placerville, CA 95667-5746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 14/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G2910204 | (05) | CA |
A43954 | (02) |