Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | 259833-1205 | UT |
Y | 2081P2900X | Pain Medicine | G149823 | CA |
NPI | 1225089790 |
---|---|
Provider Name | Dr. Gregory J Miller |
First Address | Salt Lake City, UT 84124-1214 |
Second Address | Saint Helena, CA 94574-9554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 15/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C75712 | (02) | UT |
D1105 | (05) | UT |
P00265120 | RAILROAD MEDICARE (01) | UT |