Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 2000153025 | MO |
NPI | 1124009212 |
---|---|
Provider Name | Dr. Christopher M Miller |
First Address | Springfield, MO 65807-7310 |
Second Address | Springfield, MO 65807-7310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 31/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2000153025 | STATE LICENSE (01) | MO |
204971717 | (05) | MO |
H00167 | (02) |