Provider Demographics
NPI:1578595187
Name:MILLER, DAVID S (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:971 LAKELAND DR STE 656
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4608
Mailing Address - Country:US
Mailing Address - Phone:601-366-6606
Mailing Address - Fax:601-366-6647
Practice Address - Street 1:971 LAKELAND DR STE 656
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4608
Practice Address - Country:US
Practice Address - Phone:601-366-6606
Practice Address - Fax:601-366-6647
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS15802208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119953Medicaid
B58927Medicare UPIN