Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 29942 | AL |
Y | 111NI0900X | Internist | 29942 | AL |
N | 207RH0002X | Hospice and Palliative Medicine | 29942 | AL |
NPI | 1104087469 |
---|---|
Provider Name | John Phillip Miller |
First Address | Tuscaloosa, AL 35404-2959 |
Second Address | Tuscaloosa, AL 35404-2959 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2008 |
Last Update Date | 05/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
139452 | (05) | AL |
P01059542 | RAILROAD MEDICARE (01) | AL |