Provider Demographics
NPI:1396722484
Name:MILLER, HARRIET M (MD)
Entity type:Individual
Prefix:DR
First Name:HARRIET
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 DOYLE PARK DR
Mailing Address - Street 2:SUITE G06
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4558
Mailing Address - Country:US
Mailing Address - Phone:707-573-8984
Mailing Address - Fax:707-573-0982
Practice Address - Street 1:500 DOYLE PARK DR
Practice Address - Street 2:SUITE G06
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4558
Practice Address - Country:US
Practice Address - Phone:707-573-8984
Practice Address - Fax:707-573-0982
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2016-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30542207P00000X, 207PH0002X
CAC56056207PH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01305424Medicaid
COF61235Medicare UPIN
CO313098Medicare ID - Type Unspecified