Provider Demographics
NPI:1699825497
Name:MILLER, COREY MITCHELL (IDC)
Entity Type:Individual
Prefix:MR
First Name:COREY
Middle Name:MITCHELL
Last Name:MILLER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64047 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-7717
Mailing Address - Country:US
Mailing Address - Phone:858-336-1519
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL TWENTYNINE PALMS BLDG 1145 STURGIS ST.
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92278-8250
Practice Address - Country:US
Practice Address - Phone:760-830-2194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman