Provider Demographics
NPI:1407969124
Name:MILLER, GARY DONALD (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:DONALD
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5151 ADANSON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-1330
Mailing Address - Country:US
Mailing Address - Phone:407-875-0028
Mailing Address - Fax:407-691-4573
Practice Address - Street 1:5151 ADANSON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-1330
Practice Address - Country:US
Practice Address - Phone:407-875-0028
Practice Address - Fax:407-691-4573
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL24102207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD55415Medicare UPIN