Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 2001014935 | MO |
Y | 208600000X | Surgeon | 2001014935 | MO |
NPI | 1023061413 |
---|---|
Provider Name | Marc L Miller |
First Address | Columbia, MO 65205-7687 |
Second Address | Columbia, MO 65203-3244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 20/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G49791 | (02) | |
P00415656 | RAILROAD MEDICARE (01) | MO |