Provider Demographics
NPI:1164450102
Name:MILLER, PAUL RUDOLPH (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:RUDOLPH
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 1:214 MATHESON ST
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448
Mailing Address - Country:US
Mailing Address - Phone:707-433-3355
Mailing Address - Fax:707-433-7745
Practice Address - Street 1:214 MATHESON ST
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448
Practice Address - Country:US
Practice Address - Phone:707-433-3355
Practice Address - Fax:707-433-7745
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG17933207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9150917Medicaid
A40229Medicare UPIN
CA9150917Medicaid