Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | A69934 | CA |
NPI | 1215005327 |
---|---|
Provider Name | Martin Brier Miller |
First Address | Los Gatos, CA 95032-2632 |
Second Address | Los Gatos, CA 95032-2632 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G92236 | (02) |