Provider Demographics
NPI:1619982469
Name:JAMES S. MILLER M.D., P. A.
Entity Type:Organization
Organization Name:JAMES S. MILLER M.D., P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-477-6190
Mailing Address - Street 1:4541 N DAVIS HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2783
Mailing Address - Country:US
Mailing Address - Phone:850-477-6190
Mailing Address - Fax:
Practice Address - Street 1:4541 N DAVIS HWY
Practice Address - Street 2:SUITE B
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2783
Practice Address - Country:US
Practice Address - Phone:850-477-6190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22150207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL406071306OtherRRB PTAN
FL17314Medicare PIN
FL406071306OtherRRB PTAN