Provider Demographics
NPI:1225119951
Name:ROBERT BRUCE MILLER, M.D.,INC.
Entity Type:Organization
Organization Name:ROBERT BRUCE MILLER, M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-795-7746
Mailing Address - Street 1:PO BOX 8310
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94537-8310
Mailing Address - Country:US
Mailing Address - Phone:510-795-7745
Mailing Address - Fax:510-795-7710
Practice Address - Street 1:4535 MATTOS DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-6736
Practice Address - Country:US
Practice Address - Phone:510-795-7746
Practice Address - Fax:510-795-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76380174400000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A763800Medicaid
CA352194600OtherOWCP #
CA250013702OtherRR MEDICARE PROV #
CAA76380OtherLIC #
CA00A763800Medicaid
CAH56244Medicare UPIN
CA00A763800Medicare ID - Type UnspecifiedMEDICARE PROV #