Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | D5415 | AZ |
Y | 213EG0000X | General Practice | D5415 | AZ |
NPI | 1003027830 |
---|---|
Provider Name | Clyde Edward Miller |
First Address | Scottsdale, AZ 85262-3656 |
Second Address | Scottsdale, AZ 85260-1505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 08/07/2007 |