Provider Demographics
NPI:1730185992
Name:MILLER, BOBBY RAY JR (MD)
Entity type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:RAY
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1011 N CHINA LAKE BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3130
Mailing Address - Country:US
Mailing Address - Phone:760-449-7222
Mailing Address - Fax:760-446-7228
Practice Address - Street 1:1041 N CHINA LAKE BLVD
Practice Address - Street 2:STE C
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3189
Practice Address - Country:US
Practice Address - Phone:760-446-4875
Practice Address - Fax:760-446-2165
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2015-03-10
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Provider Licenses
StateLicense IDTaxonomies
CAC50884207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF74363Medicare UPIN
CAZZZ32383ZMedicare ID - Type UnspecifiedGROUP ID
CA00C508842Medicare ID - Type UnspecifiedPPIN