Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 74380 | MA |
NPI | 1063471126 |
---|---|
Provider Name | Mr. S David Miller |
First Address | North Dartmouth, MA 02747-3300 |
Second Address | North Dartmouth, MA 02747-3300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2006 |
Last Update Date | 05/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3078299 | (05) | MA |
E86714 | (02) |