Healthcare Provider Details

I. General information

NPI: 1376598920
Provider Name (Legal Business Name): BRUCE L MILLER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCSF 521 PARNASSUS AVE, SUITE C-126
SAN FRANCISCO CA
94143-0001
US

IV. Provider business mailing address

PO BOX 366
RANCHO SANTA FE CA
92067-0366
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-7104
  • Fax: 415-476-5020
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number227187
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberA88083
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: