Provider Demographics
NPI:1396814125
Name:MILLER, STEPHEN R (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 SW 34TH CIRCLE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474
Mailing Address - Country:US
Mailing Address - Phone:352-861-0444
Mailing Address - Fax:352-861-0464
Practice Address - Street 1:3301 SW 34TH CIRCLE
Practice Address - Street 2:SUITE 102
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474
Practice Address - Country:US
Practice Address - Phone:352-861-0444
Practice Address - Fax:352-861-0464
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP00001605213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029711903Medicaid
T80785Medicare UPIN
FL029711903Medicaid
FL1311260001Medicare NSC