MEDICARE: DR. RUSSELL D. MILLER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	G23676	CA

General Provider Information

NPI Number	:	1164740411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL D. MILLER M.D.

Provider Business Mailing Address
First Line	:	7160 SEAWIND DR
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7160 SEAWIND DR
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4316
Country	:	US
Telephone Number	:	562-598-0608
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2010
Last Update Date	:	05/12/2010

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