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General NPI Number Information
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NPI Number | 1033420583
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Entity Type | Organization
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Legal Business Name | D LARRY MILLER M D A PROFESSIONAL CORP
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Dates
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Enumeration Date | 06/30/2010
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Last Update Date | 02/20/2013
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Provider Practice Location Address
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Address Line | 6585 CLARK RD STE 440
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City | PARADISE
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State | CA
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Zip | 95969-3500
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Country | US
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Telephone | 530-877-4465
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Fax |
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Provider Business Mailing Address
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Address Line | 6585 CLARK RD STE 440
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City | PARADISE
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State | CA
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Zip | 95969-3500
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Country | US
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Telephone | 530-877-4465
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. D LARRY MILLER
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Credential | M.D.
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Telephone | 530-877-4465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | G206710
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License Number State | CA
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