Provider Demographics
NPI:1477217347
Name:MILLER, JAMES LEON JR
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LEON
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 103 BOX 5091
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09603-0051
Mailing Address - Country:US
Mailing Address - Phone:931-802-1822
Mailing Address - Fax:
Practice Address - Street 1:PSC 103 BOX 5091
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09603-0051
Practice Address - Country:US
Practice Address - Phone:931-802-1822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians