Provider Demographics
NPI:1154331304
Name:MILLER, BAYARD DODGE SR (MD)
Entity Type:Individual
Prefix:DR
First Name:BAYARD
Middle Name:DODGE
Last Name:MILLER
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BAYARD
Other - Middle Name:D
Other - Last Name:MILLER
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1401 CENTERVILLE RD
Mailing Address - Street 2:SUITE 504
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4647
Mailing Address - Country:US
Mailing Address - Phone:850-431-5037
Mailing Address - Fax:850-431-6101
Practice Address - Street 1:1401 CENTERVILLE RD
Practice Address - Street 2:SUITE 504
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4647
Practice Address - Country:US
Practice Address - Phone:850-431-5037
Practice Address - Fax:850-431-6101
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME248712084N0400X
NC2013-010152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL059244700Medicaid
FL17377OtherBLUE CROSS BLUE SHIELD
D53255Medicare UPIN
FL17377OtherBLUE CROSS BLUE SHIELD