Provider Demographics
NPI:1649383621
Name:DAVID S. MILLER, MD, PLLC
Entity Type:Organization
Organization Name:DAVID S. MILLER, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-366-6606
Mailing Address - Street 1:971 LAKELAND DR
Mailing Address - Street 2:SUITE 1252
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4643
Mailing Address - Country:US
Mailing Address - Phone:601-366-6606
Mailing Address - Fax:601-366-6647
Practice Address - Street 1:971 LAKELAND DR
Practice Address - Street 2:SUITE 1252
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4643
Practice Address - Country:US
Practice Address - Phone:601-366-6606
Practice Address - Fax:601-366-6647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15802208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSCG1380OtherRR MEDICARE
MS05650361Medicaid
MS05650361Medicaid