Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G25487 | CA |
NPI | 1053463760 |
---|---|
Provider Name | Robert Mitchell Miller |
First Address | Long Beach, CA 90808-4132 |
Second Address | Long Beach, CA 90808-4132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A42683 | (02) |