Provider Demographics
NPI:1265473474
Name:MILLER, JASON M (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:M
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:555 N EL CAMINO REAL
Mailing Address - Street 2:A389
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-6740
Mailing Address - Country:US
Mailing Address - Phone:949-612-2727
Mailing Address - Fax:949-612-2727
Practice Address - Street 1:3142 VISTA WAY
Practice Address - Street 2:STE 207
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3619
Practice Address - Country:US
Practice Address - Phone:760-610-0522
Practice Address - Fax:760-610-0523
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2012-05-29
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Provider Licenses
StateLicense IDTaxonomies
CAA82629207L00000X
CAA082629208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI30039Medicare UPIN