Healthcare Provider Details

I. General information

NPI: 1801967617
Provider Name (Legal Business Name): LARRY MILLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29369 AUBERRY RD 102
PRATHER CA
93651-9784
US

IV. Provider business mailing address

29369 AUBERRY RD 102
PRATHER CA
93651-9784
US

V. Phone/Fax

Practice location:
  • Phone: 559-855-5390
  • Fax: 559-855-5395
Mailing address:
  • Phone: 559-855-5390
  • Fax: 559-855-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A9261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: