Provider Demographics
NPI:1124355797
Name:GERALD W. MILLER, MD A PROFFESSIONAL CORP
Entity type:Organization
Organization Name:GERALD W. MILLER, MD A PROFFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-377-6303
Mailing Address - Street 1:3816 WOODRUFF AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-2147
Mailing Address - Country:US
Mailing Address - Phone:562-377-6303
Mailing Address - Fax:562-420-2285
Practice Address - Street 1:3816 WOODRUFF AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-2147
Practice Address - Country:US
Practice Address - Phone:562-377-6303
Practice Address - Fax:562-420-2285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A180270Medicaid
CAA18027Medicare PIN
CA00A180270Medicaid