Provider Demographics
NPI:1629090790
Name:MILLER, DAVID E (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7322
Mailing Address - Country:US
Mailing Address - Phone:850-494-2039
Mailing Address - Fax:850-494-2043
Practice Address - Street 1:6420 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7322
Practice Address - Country:US
Practice Address - Phone:850-494-2039
Practice Address - Fax:850-494-2043
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9816207P00000X, 207Q00000X
ALDO.1443207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00395910OtherMEDICARE RAILROAD
ILP00263797OtherMEDICARE RAILROAD
IL036114244Medicaid
ILP00263797OtherMEDICARE RAILROAD
IL036114244Medicaid
ILK21860Medicare ID - Type Unspecified