Provider Demographics
NPI:1679717938
Name:JAMES A.MILLER JR.,MD,PA
Entity Type:Organization
Organization Name:JAMES A.MILLER JR.,MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-727-3833
Mailing Address - Street 1:742 HAWKSBILL ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3851
Mailing Address - Country:US
Mailing Address - Phone:321-727-3833
Mailing Address - Fax:321-727-6061
Practice Address - Street 1:1101 W HIBISCUS BLVD
Practice Address - Street 2:#201
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2718
Practice Address - Country:US
Practice Address - Phone:321-727-3833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00470152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25360990Medicaid
FLD79812Medicare PIN