Provider Demographics
NPI:1790965382
Name:MILLER, DANIEL JEZZARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JEZZARD
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:PO BOX 295
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-0295
Mailing Address - Country:US
Mailing Address - Phone:865-385-4713
Mailing Address - Fax:
Practice Address - Street 1:326 BLOUNT ST
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-1372
Practice Address - Country:US
Practice Address - Phone:865-385-4713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42990208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice