Provider Demographics
NPI:1093851552
Name:MILLER, J. FRED III (MD)
Entity Type:Individual
Prefix:
First Name:J.
Middle Name:FRED
Last Name:MILLER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 E MACEWEN DR
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-8000
Mailing Address - Country:US
Mailing Address - Phone:941-468-8600
Mailing Address - Fax:941-966-8783
Practice Address - Street 1:398 E MACEWEN DR
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-8000
Practice Address - Country:US
Practice Address - Phone:941-468-8600
Practice Address - Fax:941-966-8783
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11770207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD53620Medicare UPIN