Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 51560 | AZ |
NPI | 1306163480 |
---|---|
Provider Name | Derek J Miller |
First Address | Tucson, AZ 85728-4369 |
Second Address | Dallas, TX 75235-7708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2010 |
Last Update Date | 24/09/2020 |