Provider Demographics
NPI:1053461053
Name:MILLER, FLOYD I (DPM)
Entity Type:Individual
Prefix:
First Name:FLOYD
Middle Name:I
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2034 E SOUTHERN AVE STE W
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7519
Mailing Address - Country:US
Mailing Address - Phone:480-219-3766
Mailing Address - Fax:480-219-3768
Practice Address - Street 1:2175 N ALMA SCHOOL RD STE C109
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2880
Practice Address - Country:US
Practice Address - Phone:480-545-2610
Practice Address - Fax:480-545-2673
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0548213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2Z0121OtherHEALTHNET OF AZ
AZP00409461OtherRR MEDICARE
AZ612459Medicaid
AZ612459Medicaid
AZ114199Medicare PIN
AZ6002400001Medicare NSC