Provider Demographics
NPI:1285682344
Name:MILLER, LOREN JEFFERY (DPM)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:JEFFERY
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4167 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-6303
Mailing Address - Country:US
Mailing Address - Phone:727-321-3100
Mailing Address - Fax:727-327-6800
Practice Address - Street 1:4167 5TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-6303
Practice Address - Country:US
Practice Address - Phone:727-321-3100
Practice Address - Fax:727-327-6800
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP01707213E00000X
FLPO1707213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029772100Medicaid
FL87948Medicare PIN
FL029772100Medicaid