Provider Demographics
NPI:1942352497
Name:MILLER, GEOFFREY MARC (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:MARC
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 1:880 APOLLO ST
Mailing Address - Street 2:#243
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4700
Mailing Address - Country:US
Mailing Address - Phone:310-524-9091
Mailing Address - Fax:310-524-9092
Practice Address - Street 1:880 APOLLO ST
Practice Address - Street 2:#243
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4700
Practice Address - Country:US
Practice Address - Phone:310-524-9091
Practice Address - Fax:310-524-9092
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43516207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG435160Medicaid
CACMS165200OtherCMS
CA00G435161Medicaid
CAW5930AMedicare UPIN