Provider Demographics
NPI:1225224462
Name:MILLER, GREGG ADAM (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GREGG
Middle Name:ADAM
Last Name:MILLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8281 SILVER BIRCH WAY
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-3721
Mailing Address - Country:US
Mailing Address - Phone:239-332-8476
Mailing Address - Fax:
Practice Address - Street 1:8281 SILVER BIRCH WAY
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-3721
Practice Address - Country:US
Practice Address - Phone:239-332-8476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9102996363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant