Provider Demographics
NPI:1053463760
Name:MILLER, ROBERT MITCHELL (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MITCHELL
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 PALO VERDE AVE #107
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-4132
Mailing Address - Country:US
Mailing Address - Phone:562-420-8333
Mailing Address - Fax:562-420-8433
Practice Address - Street 1:3325 PALO VERDE AVE #107
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-4132
Practice Address - Country:US
Practice Address - Phone:562-420-8333
Practice Address - Fax:562-420-8433
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25487207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A42683Medicare UPIN
W17862Medicare ID - Type Unspecified