Provider Demographics
NPI:1255317681
Name:MILLER, WILLIAM BRADLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRADLEY
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 1:103 PROVIDENCE MINE RD
Mailing Address - Street 2:SUITE 104 D
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-2941
Mailing Address - Country:US
Mailing Address - Phone:530-478-1536
Mailing Address - Fax:530-478-1536
Practice Address - Street 1:103 PROVIDENCE MINE RD
Practice Address - Street 2:SUITE 104 D
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2941
Practice Address - Country:US
Practice Address - Phone:530-478-1536
Practice Address - Fax:530-478-1536
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52487207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G524870Medicaid
CA00G524870Medicaid
A52275Medicare UPIN