Provider Demographics
NPI:1467773564
Name:MILLER, JARED WESLEY (DO)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:WESLEY
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1144 N ROAD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3473
Mailing Address - Country:US
Mailing Address - Phone:252-384-2360
Mailing Address - Fax:252-384-2359
Practice Address - Street 1:1144 N ROAD ST STE 200
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3473
Practice Address - Country:US
Practice Address - Phone:252-384-2360
Practice Address - Fax:252-384-2359
Is Sole Proprietor?:No
Enumeration Date:2010-06-13
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2013-00283207Q00000X, 207QS0010X
VA0102203100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine