Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | 4719 | AZ |
NPI | 1669514030 |
---|---|
Provider Name | Richard Charles Miller |
First Address | Tucson, AZ 85748 |
Second Address | Tucson, AZ 85712-2152 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 08/07/2007 |