=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457516676
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEON MILLER, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2008
-----------------------------------------------------
Last Update Date | 07/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 839 C PASEO DE PERALTA
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-982-3111
-----------------------------------------------------
Fax | 505-982-1148
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1202 GALISTEO STREET
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-982-3111
-----------------------------------------------------
Fax | 505-982-1148
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DOCTOR - OWNER
-----------------------------------------------------
Name | DR. LEON MILLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 505-982-3111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------