Provider Demographics
NPI:1316166770
Name:MILLER, DONALD BERNARD (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:BERNARD
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1141 W REDONDO BEACH BLVD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3586
Mailing Address - Country:US
Mailing Address - Phone:310-515-1055
Mailing Address - Fax:310-515-7685
Practice Address - Street 1:1141 W REDONDO BEACH BLVD
Practice Address - Street 2:SUITE 406
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3586
Practice Address - Country:US
Practice Address - Phone:310-515-1055
Practice Address - Fax:310-515-7685
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG16968207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G16968Medicaid
CAA90464Medicare UPIN
CAG16968Medicare ID - Type Unspecified