MEDICARE: ROBERT MITCHELL MILLER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	G25487	CA

General Provider Information

NPI Number	:	1053463760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT MITCHELL MILLER MD

Provider Business Mailing Address
First Line	:	3325 PALO VERDE AVE #107
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-4132
Country	:	US
Telephone Number	:	562-420-8333
Fax Number	:	562-420-8433

Provider Business Practice Location Address
First Line	:	3325 PALO VERDE AVE #107
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-4132
Country	:	US
Telephone Number	:	562-420-8333
Fax Number	:	562-420-8433

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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