Provider Demographics
NPI:1235110750
Name:MILLER, BRUCE C (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:C
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 1:2780 EUREKA WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001
Mailing Address - Country:US
Mailing Address - Phone:530-229-0360
Mailing Address - Fax:530-229-0856
Practice Address - Street 1:2780 EUREKA WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-229-0360
Practice Address - Fax:530-229-0856
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87380207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G873800Medicaid
CAF48688Medicare UPIN
CA00G873800Medicare ID - Type Unspecified