Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 32609 | AZ |
NPI | 1114005253 |
---|---|
Provider Name | Michael David Miller |
First Address | Tucson, AZ 85718-5831 |
Second Address | Tucson, AZ 85718-5831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
857724 | AHCCCS (01) | AZ |
H96172 | (02) |