Provider Demographics
NPI:1275586885
Name:MILLER, CYNTHIA E (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:E
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:E
Other - Last Name:JAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1144
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34681-1144
Mailing Address - Country:US
Mailing Address - Phone:727-902-4680
Mailing Address - Fax:
Practice Address - Street 1:978 POINT SEASIDE DRIVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL BEACH
Practice Address - State:FL
Practice Address - Zip Code:34681-1144
Practice Address - Country:US
Practice Address - Phone:727-902-4680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101885207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000517600Medicaid
FLP00656945OtherRAILROAD MEDICARE PROVIDER NUMBER
FL000517600Medicaid