Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | G58639 | CA |
NPI | 1043338163 |
---|---|
Provider Name | Damon P Miller II |
First Address | Palo Alto, CA 94303-0399 |
Second Address | Redwood City, CA 94063-4158 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 19/12/2012 |