Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 26209 | CA |
Y | 213EG0000X | General Practice | 26209 | CA |
NPI | 1003800137 |
---|---|
Provider Name | Dr. Gregory Miyake |
First Address | Fresno, CA 93710-7801 |
Second Address | Fresno, CA 93710-7801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2005 |
Last Update Date | 08/07/2007 |