JACK EDWIN MILLER (NPI# 1497824627) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497824627 |
| Entity Type | Individual |
| Full Name | JACK EDWIN MILLER |
| Credential | MD |
| Practice Address |
765 Baywood Dr #231 Petaluma CA 94954 |
| Practice Telephone | 7077622166 |
| Practice Fax Number | 7077668160 |
| Mailing Telephone | 7077622166 |
| Mailing Fax Number | 7077668160 |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
G26214 | CA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528444304 | Jack Miller | Pharmacist | 1262 S. Conwell Stc, Casper, WY 82601 | 2015-08-04 |
| 1396127569 | Jack Parker Miller Jr. | Family Medicine | 2000 E Greenville St Ste 3600, Anmed Health Family Medicine Residency Prog., Anderson, SC 29621-1725 | 2015-06-24 |
| 1407130198 | Jack Lawrence Miller | Massage Therapist | 7620 N Hartman Ln Ste 184, Tucson, AZ 85743-7485 | 2011-09-29 |
| 1619274867 | Jack Glenn Miller | Naturopath | 1308 N Stockton Hill Rd Ste A-153, Kingman, AZ 86401-5139 | 2011-02-24 |
| 1033350889 | Jack M. Miller | Obstetrics & Gynecology | 6406 E 108th St, Tulsa, OK 74137-8907 | 2009-03-07 |
| 1073770764 | Jack Randolph Miller | Dentist | 2078 Ne Professional Ct, Bend, OR 97701-6077 | 2008-05-20 |
| 1801912191 | Jack L Miller | Preventive Medicine | 220 Cobb Pkwy N, Suite 400, Marietta, GA 30062-3581 | 2007-03-21 |
| 1245377589 | Jack A Miller | Psychiatry & Neurology | 384 West Rd, Alford, MA 01266-9756 | 2007-01-30 |
| 1598830465 | Jack J. Miller | Dentist | 3716 Pontoon Rd, Granite City, IL 62040-4252 | 2006-11-22 |
| 1942288949 | Jack W. Miller | Dentist | 2203 Sweetbriar St, Wichita, KS 67204-5518 | 2006-01-09 |
| Street Address |
765 BAYWOOD DR #231 |
| City | PETALUMA |
| State | CA |
| Zip Code | 94954 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700075975 | Christopher Michael Rosenthal | Dentist | 765 Baywood Dr, Suite 233, Petaluma, CA 94954-5503 | 2007-10-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346883840 | Miguel Ibarra | Counselor | 5350 Old Redwood Highway, Petaluma, CA 94954 | 2019-10-28 |
| 1073169223 | Monica Renee Najera | Behavior Technician | 1670 Corporate Circle, Ste. 100, Petaluma, CA 94954 | 2019-08-14 |
| 1326607201 | Making Magic Happen - People Helping People, Inc. | Marriage & Family Therapist | 1318 Redwood Way, Suite 260, Petaluma, CA 94954 | 2019-06-13 |
| 1477019917 | Rubi Isela Cruz Mendoza I | Behavioral Analyst | 8 Round Walk Circle, Petaluma, CA 94954 | 2019-02-20 |
| 1932679511 | Karen Christianson | Behavior Technician | 1670 Corporate Circle Suite 100, Petaluma, CA 94954 | 2018-11-27 |
| 1669956967 | Alyssa Messer | Assistant Behavior Analyst | 1670 Corporate Cir, Petaluma, CA 94954 | 2018-09-21 |
| 1235620592 | Mallory Paige Mullikin | Nurse Practitioner | 141 Lynch Creek Trail, Ste C, Petaluma, CA 94954 | 2018-05-22 |
| 1457723710 | Lisabel Dolne | Counselor | 1360 N. Mcdowell Blvd.1a, Petaluma, CA 94954 | 2015-10-27 |
| 1083080717 | Pacific Restorative Center | Clinic/Center | 1456 Professional Drive, Suite 404, Petaluma, CA 94954 | 2015-08-17 |
| 1619354198 | Accu Quest Hearing Centers | Clinic/Center | 1456 Professional Dr., Suite 404, Petaluma, CA 94954 | 2015-05-04 |
| Find all providers in zip 94954 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134132806 | Edward L Spencer | Psychiatry & Neurology | 47 Maria Dr, #811b, Petaluma, CA 94954 | 2006-08-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
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| 1710592431 | Muhammad Amin | Psychiatry & Neurology | 33433 Pony Loop, Fremont, CA 94555-3511 | 2020-09-10 |
| 1558973792 | Catalyst Neuromedical Center PC | Psychiatry & Neurology | 3305 Placer St Ste B, Redding, CA 96001-2378 | 2020-08-19 |
| 1134730906 | West Coast Valley Medical Inc | Psychiatry & Neurology | 3357 Cahuenga Blvd W # 18, Los Angeles, CA 90068-1327 | 2020-08-13 |
| 1720603582 | Lily Wenya Zhou | Psychiatry & Neurology | 780 Welch Road, Suite 350, Stanford Stroke Center, Palo Alto, CA 94304 | 2020-06-08 |
| 1760015689 | Simon James Little | Psychiatry & Neurology | 1634 Divisadero St, Suite 250, San Francisco, CA 94115 | 2020-02-19 |
| 1427689256 | Alejandro F Centurion Md Inc | Psychiatry & Neurology | 100 Clock Tower Pl Ste 225, Carmel, CA 93923-8778 | 2020-01-30 |
| 1659901254 | Kern County Neurological Medical Group, Inc | Psychiatry & Neurology | 18645 Gale Ave Ste 228b, City of Industry, CA 91748-1363 | 2020-01-22 |
| 1609415314 | Aspire Holdings, Inc | Psychiatry & Neurology | 28212 Kelly Johnson Pkwy Ste 215, Valencia, CA 91355-5090 | 2019-12-27 |
| 1336785187 | Tp-health Ca PC | Psychiatry & Neurology | 201 E Center St Ste 112, Anaheim, CA 92805-7212 | 2019-11-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.