Provider Demographics
NPI:1013985340
Name:MILLER, WALTER SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:SCOTT
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 1:10042 WOLF ROAD SUITE A
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949
Mailing Address - Country:US
Mailing Address - Phone:530-268-8778
Mailing Address - Fax:530-268-8765
Practice Address - Street 1:10042 WOLF ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949
Practice Address - Country:US
Practice Address - Phone:530-268-8778
Practice Address - Fax:530-268-8765
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0G53577174400000X
CAG53577207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF18268Medicare UPIN
CA00G535771Medicare PIN