Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0203X | Pediatric Critical Care Doctor | 98-339 | NM |
Y | 2080P0210X | Pediatric Nephrologist | 98-339 | NM |
NPI | 1477559425 |
---|---|
Provider Name | Dr. Robert Benjamin Miller |
First Address | Las Cruces, NM 88004-1560 |
Second Address | Albuquerque, NM 87107-6834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 05/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G21285 | (02) | NM |
T9873 | (05) | NM |