Healthcare Provider Details

I. General information

NPI: 1902879067
Provider Name (Legal Business Name): LAWRENCE ROSS MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 WILSHIRE BLVD STE 1018
BEVERLY HILLS CA
90211-3108
US

IV. Provider business mailing address

PO BOX 515110
LOS ANGELES CA
90051-5110
US

V. Phone/Fax

Practice location:
  • Phone: 310-747-7246
  • Fax: 310-439-7246
Mailing address:
  • Phone: 310-657-2202
  • Fax: 310-289-9933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberG59739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: