Provider Demographics
NPI:1437319332
Name:BOBBY R MILLER MD MEDICAL CORPORATION
Entity Type:Organization
Organization Name:BOBBY R MILLER MD MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:760-499-7222
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93556-0129
Mailing Address - Country:US
Mailing Address - Phone:760-499-7222
Mailing Address - Fax:760-499-7228
Practice Address - Street 1:1011 N CHINA LAKE BLVD
Practice Address - Street 2:STE. A
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3130
Practice Address - Country:US
Practice Address - Phone:760-499-7222
Practice Address - Fax:760-499-7228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC508842207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ32383ZMedicare PIN
CAF74363Medicare UPIN