Provider Demographics
NPI:1992723209
Name:MILLER, TIMOTHY ROBERT (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ROBERT
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 JOURNEY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3332
Mailing Address - Country:US
Mailing Address - Phone:949-215-5402
Mailing Address - Fax:
Practice Address - Street 1:2 JOURNEY
Practice Address - Street 2:SUITE 208
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3332
Practice Address - Country:US
Practice Address - Phone:949-215-5402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA909582082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A909580OtherBLUE SHIELD
CAA90958OtherLICENSE #
CAI56580Medicare UPIN
CAA90958OtherLICENSE #