Provider Demographics
NPI:1174502439
Name:MILLER, GREGORY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:300 CONTINENTAL BLVD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-5042
Mailing Address - Country:US
Mailing Address - Phone:310-765-2003
Mailing Address - Fax:314-292-1284
Practice Address - Street 1:300 CONTINENTAL BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-5042
Practice Address - Country:US
Practice Address - Phone:310-765-2003
Practice Address - Fax:314-292-1284
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
CAG320712084P0800X
AZ327492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91396Medicare UPIN