Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 9500410 | NC |
Y | 208600000X | Surgeon | 9500410 | NC |
N | 2086S0102X | Surgical Critical Care | 9500410 | NC |
N | 2086S0127X | Trauma Surgeon | 9500410 | NC |
NPI | 1306822903 |
---|---|
Provider Name | Preston Roy Miller |
First Address | Charlotte, NC 28260-2658 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 08/02/2017 |