Provider Demographics
NPI:1225130156
Name:MILLER, RUSSELL PAUL (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:PAUL
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 1:5900 COYLE AVE #A
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0429
Mailing Address - Country:US
Mailing Address - Phone:916-344-9400
Mailing Address - Fax:916-344-9401
Practice Address - Street 1:5900 COYLE AVE #A
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0429
Practice Address - Country:US
Practice Address - Phone:916-344-9400
Practice Address - Fax:916-344-9401
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42376207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225130156OtherNPI
CA00G423760Medicaid
CA00G423760Medicare PIN
A48931Medicare UPIN