Provider Demographics
NPI:1851331821
Name:MILLER, MARY BETH (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8485 SE 165TH MULBERRY LN
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-5847
Mailing Address - Country:US
Mailing Address - Phone:352-323-9545
Mailing Address - Fax:352-674-9859
Practice Address - Street 1:8485 SE 165TH MULBERRY LN
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5847
Practice Address - Country:US
Practice Address - Phone:352-323-9545
Practice Address - Fax:352-674-9859
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS427098207Q00000X
FLME156486207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100301520BMedicaid
KS101712OtherBCBS
G68373Medicare UPIN