Provider Demographics
NPI:1649200023
Name:MILLER, ALAN KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:KEITH
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:200 3RD AVE W
Practice Address - Street 2:SUITE 210
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8626
Practice Address - Country:US
Practice Address - Phone:941-792-0340
Practice Address - Fax:941-567-3171
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME80500208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7122356OtherAETNA
FLP01040808OtherRAILROAD MCR
FL127097OtherUNIVERSAL
FL353769OtherAVMED
FL012606800Medicaid
FL1193409OtherWELLCARE
FLP102260OtherFREEDOM HEALTH
FLP512317OtherOPTIMUM
FL81883OtherBCBS FL
FLP01040808OtherRAILROAD MCR
FL127097OtherUNIVERSAL