Provider Demographics
NPI:1790954782
Name:MILLER FAMILY MEDICINE AND MINOR TRAUMA
Entity Type:Organization
Organization Name:MILLER FAMILY MEDICINE AND MINOR TRAUMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-268-8778
Mailing Address - Street 1:10042 WOLF RD STE A
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-8192
Mailing Address - Country:US
Mailing Address - Phone:530-268-8778
Mailing Address - Fax:530-268-8765
Practice Address - Street 1:10042 WOLF RD STE A
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-8192
Practice Address - Country:US
Practice Address - Phone:530-268-8778
Practice Address - Fax:530-268-8765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02227ZMedicare PIN