Healthcare Provider Details

I. General information

NPI: 1205845153
Provider Name (Legal Business Name): ROBERT MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 SACRAMENTO ST SUITE 150
SAN FRANCISCO CA
94115-2383
US

IV. Provider business mailing address

PO BOX 254947
SACRAMENTO CA
95865-4947
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-3604
  • Fax: 415-923-6567
Mailing address:
  • Phone: 916-854-6975
  • Fax: 916-854-6844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG21518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: