Provider Demographics
NPI:1801967617
Name:MILLER, LARRY (DO)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:29369 AUBERRY RD
Mailing Address - Street 2:102
Mailing Address - City:PRATHER
Mailing Address - State:CA
Mailing Address - Zip Code:93651-9784
Mailing Address - Country:US
Mailing Address - Phone:559-855-5390
Mailing Address - Fax:559-855-5395
Practice Address - Street 1:29369 AUBERRY RD
Practice Address - Street 2:102
Practice Address - City:PRATHER
Practice Address - State:CA
Practice Address - Zip Code:93651-9784
Practice Address - Country:US
Practice Address - Phone:559-855-5390
Practice Address - Fax:559-855-5395
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A9261207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A92611Medicare PIN