Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 02480 | AZ |
N | 207V00000X | Obstetrician & Gynecologist | 1279 | VI |
NPI | 1003817263 |
---|---|
Provider Name | Dr. Edward John Miller JR. |
First Address | Bisbee, AZ 85603-1327 |
Second Address | Douglas, AZ 85607-2859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 02/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E65869 | (02) |