Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 143 | NC |
N | 213ES0103X | Foot & Ankle Surgery | 143 | NC |
NPI | 1194723809 |
---|---|
Provider Name | Dr. Richard J. Miller |
First Address | Charlotte, NC 28210-8508 |
Second Address | Charlotte, NC 28210-8508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 09/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8908123 | (05) | NC |
T64106 | (02) | NC |