Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | M3815 | ID |
NPI | 1013906049 |
---|---|
Provider Name | Warren N. Miller |
First Address | Nampa, ID 83686-6811 |
Second Address | Nampa, ID 83687-9203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 26/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000010005751 | BLUE SHIELD (01) | ID |
000010138751 | BLUE SHIELD (01) | ID |
002365600 | (05) | ID |
070004831 | RAILROAD MEDICARE (01) | ID |
28634 | BLUE CROSS (01) | ID |
38158 | BLUE CROSS (01) | ID |
C36857 | (02) |