Provider Demographics
NPI:1134224751
Name:MILLER, BRUCE DEAN (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:DEAN
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 1:1004 FOWLER WAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5746
Mailing Address - Country:US
Mailing Address - Phone:530-626-1602
Mailing Address - Fax:530-626-8636
Practice Address - Street 1:1004 FOWLER WAY
Practice Address - Street 2:SUITE 6
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5746
Practice Address - Country:US
Practice Address - Phone:530-626-1602
Practice Address - Fax:530-626-8636
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29102207N00000X, 207ND0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G2910204Medicaid
CA00G2910204Medicaid
756071203Medicare PIN
A43954Medicare UPIN