Provider Demographics
NPI:1841293271
Name:MILLER, ROBERT BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRUCE
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8310
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94537-8310
Mailing Address - Country:US
Mailing Address - Phone:510-795-7746
Mailing Address - Fax:510-795-7710
Practice Address - Street 1:4535 MATTOS DRIVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-6719
Practice Address - Country:US
Practice Address - Phone:510-795-7746
Practice Address - Fax:510-795-7710
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA76380208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A76380Medicaid
CA00A76380Medicaid
CAH56244Medicare UPIN