1134217276 NPI number — JOHN G.O. MILLER, PHD, M.D., A PROFESSIONAL CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134217276 NPI number — JOHN G.O. MILLER, PHD, M.D., A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN G.O. MILLER, PHD, M.D., A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134217276
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1759
Provider Second Line Business Mailing Address:
DEPARTMENT 952
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77251-1759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-554-5304
Provider Business Mailing Address Fax Number:
713-554-5320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39000 BOB HOPE DR
Provider Second Line Business Practice Location Address:
KIEWIT 207
Provider Business Practice Location Address City Name:
RANCHO MIRAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92270-3221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-773-3311
Provider Business Practice Location Address Fax Number:
760-773-3811
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
G.O.
Authorized Official Title or Position:
OWNER, PRES.
Authorized Official Telephone Number:
760-318-3730

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A76868 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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