Provider Demographics
NPI:1235315821
Name:DAVID B MILLER PSYD PA
Entity Type:Organization
Organization Name:DAVID B MILLER PSYD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D PA
Authorized Official - Phone:561-362-3739
Mailing Address - Street 1:7301A W PALMETTO PACK RD
Mailing Address - Street 2:SUITE 20613
Mailing Address - City:BOCO RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3466
Mailing Address - Country:US
Mailing Address - Phone:561-362-3739
Mailing Address - Fax:561-362-5595
Practice Address - Street 1:7301A W PALMETTO PARK RD
Practice Address - Street 2:SUITE 20613
Practice Address - City:BOCO RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3466
Practice Address - Country:US
Practice Address - Phone:561-362-3739
Practice Address - Fax:561-362-5595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPX6648103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74496OtherBCBS
FLK7045Medicare PIN
FL74496OtherBCBS