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General NPI Number Information
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NPI Number | 1215082391
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Entity Type | Individual
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Provider Name | SHELBY WOLFE MILLER M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1411 E 31ST ST
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City | OAKLAND
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State | CA
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Zip | 94602-1018
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Country | US
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Telephone | 510-437-4744
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Fax |
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Provider Business Mailing Address
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Address Line | 523 GRIZZLY PEAK BLVD
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City | BERKELEY
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State | CA
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Zip | 94708-1212
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207UN0902X
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Taxonomy Name | Nuclear Imaging & Therapy Physician
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License Number | C28799
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License Number State | CA
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