Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 0103000262 | VA |
NPI | 1104813385 |
---|---|
Provider Name | Dr. Joel I Miller |
First Address | Burke, VA 22015-4421 |
Second Address | Burke, VA 22015-4421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 08/07/2007 |