Provider Demographics
NPI:1982636031
Name:MILLER, DOUGLAS G (MD)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:G
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:225 W MADISON AVENUE
Mailing Address - Street 2:STE 2
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020
Mailing Address - Country:US
Mailing Address - Phone:619-442-3937
Mailing Address - Fax:619-441-0539
Practice Address - Street 1:225 W MADISON AVENUE
Practice Address - Street 2:STE 2
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020
Practice Address - Country:US
Practice Address - Phone:619-442-3937
Practice Address - Fax:619-441-0539
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG52627207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G526270Medicaid
CAG52627Medicare ID - Type Unspecified
0878900001Medicare NSC
B65562Medicare UPIN