MEDICARE: DR. ALEXANDER MILLER M.D.

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	207ND0101X	MOHS-Micrographic Surgery Physician	G42379	CA
2	207N00000X	Dermatology Physician	G42379	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437157179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER MILLER M.D.

Provider Business Mailing Address
First Line	:	17451 BASTANCHURY RD. SUITE 103A
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-1871
Country	:	US
Telephone Number	:	714-961-0143
Fax Number	:	714-961-0265

Provider Business Practice Location Address
First Line	:	17451 BASTANCHURY RD. SUITE 103A
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-1871
Country	:	US
Telephone Number	:	714-961-0143
Fax Number	:	714-961-0265

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/28/2020

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