Provider Demographics
NPI:1114903721
Name:MILKS, JEFFREY WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WILLIAM
Last Name:MILKS
Suffix:
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 1:5121 FOREST DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-7085
Mailing Address - Country:US
Mailing Address - Phone:614-933-9100
Mailing Address - Fax:614-933-9103
Practice Address - Street 1:5121 FOREST DR
Practice Address - Street 2:SUITE D
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-7085
Practice Address - Country:US
Practice Address - Phone:614-933-9100
Practice Address - Fax:614-933-9103
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045924M207P00000X, 207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A79981Medicare UPIN
OHMI4050382Medicare ID - Type Unspecified