Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | A35411 | CA |
Y | 207V00000X | Obstetrician & Gynecologist | A35411 | CA |
NPI | 1285737569 |
---|---|
Provider Name | Phillip Mark Milgram |
First Address | Carlsbad, CA 92009-8976 |
Second Address | Carlsbad, CA 92009-8976 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 01/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A27771 | (02) | CA |