Provider Demographics
NPI:1710243050
Name:MILLER, PETER MACON (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:MACON
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6877 SW 18TH ST STE H121
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-7046
Mailing Address - Country:US
Mailing Address - Phone:202-740-1981
Mailing Address - Fax:
Practice Address - Street 1:6877 SW 18TH ST STE H121
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7046
Practice Address - Country:US
Practice Address - Phone:202-740-1981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care