Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 13817 | AZ |
NPI | 1033178231 |
---|---|
Provider Name | Dr. Jess A Miller |
First Address | Fargo, ND 58122-0001 |
Second Address | Bismarck, ND 58501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 07/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
228040 | (05) | AZ |
D37313 | (02) | AZ |