Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | MD155140 | OR |
NPI | 1023102159 |
---|---|
Provider Name | Dr. Matthew Louis Miller |
First Address | Medford, OR 97504-8475 |
Second Address | Medford, OR 97504-8475 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 07/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500637216 | (05) | OR |