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NPI Code Detail

MEDICARE: JERRY MILLER MD

MEDICARE: JERRY MILLER MD
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
1207Q00000XFamily Medicine Physician31770-020WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2119340OTHERCASTATE LICENSE

General Provider Information

NPI Number : 1871543199
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRY MILLER MD
Provider Business Mailing Address
First Line : PO BOX 28199
Second Line :
City : SAN DIEGO
State : CA
Zip : 92198-0199
Country : US
Telephone Number : 858-675-3100
Fax Number : 858-618-1523
Provider Business Practice Location Address
First Line : 211 13TH ST
Second Line :
City : RAMONA
State : CA
Zip : 92065-2711
Country : US
Telephone Number : 760-789-5160
Fax Number : 760-789-6316
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 12/23/2014

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