Provider Demographics
NPI:1013018605
Name:MILLER, J. DAVID (DO)
Entity Type:Individual
Prefix:
First Name:J.
Middle Name:DAVID
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 PLUMAS ST
Mailing Address - Street 2:STE A
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991
Mailing Address - Country:US
Mailing Address - Phone:530-671-2020
Mailing Address - Fax:530-671-3096
Practice Address - Street 1:1233 PLUMAS ST
Practice Address - Street 2:STE A
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991
Practice Address - Country:US
Practice Address - Phone:530-671-2020
Practice Address - Fax:530-671-3096
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAM2876780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA080042827OtherRAILROAD MEDICARE
CAGR0070950Medicaid
CAYYY48676YMedicare ID - Type Unspecified
E69592Medicare UPIN