Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | OS4920 | FL |
NPI | 1023007242 |
---|---|
Provider Name | Richard A Miller |
First Address | Port Richey, FL 34668-6639 |
Second Address | Port Richey, FL 34668-6639 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 15/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
063207400 | (05) | FL |
E72827 | (02) |