Provider Demographics
NPI:1043291495
Name:MILLER, CRAIG ALLAN (DO)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ALLAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 HAND AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8194
Mailing Address - Country:US
Mailing Address - Phone:386-673-0517
Mailing Address - Fax:386-671-2771
Practice Address - Street 1:1400 HAND AVE
Practice Address - Street 2:SUITE K
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8194
Practice Address - Country:US
Practice Address - Phone:386-673-0517
Practice Address - Fax:386-671-2771
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260025100Medicaid
FLH11060Medicare UPIN
FL260025100Medicaid