Provider Demographics
NPI:1447218961
Name:MILLER, PADGETT (DOM, PT)
Entity Type:Individual
Prefix:DR
First Name:PADGETT
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:DOM, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 N FLAGLER DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-6555
Mailing Address - Country:US
Mailing Address - Phone:561-655-2222
Mailing Address - Fax:561-659-5240
Practice Address - Street 1:1717 N FLAGLER DR
Practice Address - Street 2:SUITE 8
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-6555
Practice Address - Country:US
Practice Address - Phone:561-655-2222
Practice Address - Fax:561-659-5240
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 1550171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY035POtherBLUE CROSS BLUE SHIELD FL
FLC0908OtherBLUE CROSS BLUE SHIELD FL
FLC0908OtherBLUE CROSS BLUE SHIELD FL