Provider Demographics
NPI:1508079526
Name:MILLER, LAURENCE ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:ALEXANDER
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:PO BOX 12386
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92039-2386
Mailing Address - Country:US
Mailing Address - Phone:619-733-2331
Mailing Address - Fax:
Practice Address - Street 1:NASSCO MEDICAL DEPARTMENT
Practice Address - Street 2:HARBOR DRIVE AND 28TH STREET
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92186-5278
Practice Address - Country:US
Practice Address - Phone:619-544-8861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 329152083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine