Healthcare Provider Details

I. General information

NPI: 1740253368
Provider Name (Legal Business Name): JERE ALAN MILLER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 HUERFANO AVE #312
SAN DIEGO CA
92117-5207
US

IV. Provider business mailing address

PO BOX 90801
SAN DIEGO CA
92169-2801
US

V. Phone/Fax

Practice location:
  • Phone: 858-560-7270
  • Fax:
Mailing address:
  • Phone: 858-560-7270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE2470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: