Healthcare Provider Details

I. General information

NPI: 1306048475
Provider Name (Legal Business Name): MARK DAVID MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 SUTTER ST FL 3 OCCUPATIONAL MEDICINE PEHSU
SAN FRANCISCO CA
94115-3006
US

IV. Provider business mailing address

1640 BIDWELL AVE
CHICO CA
95926-9642
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-7580
  • Fax:
Mailing address:
  • Phone: 530-895-8296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC41102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: