Provider Demographics
NPI:1851340103
Name:MILLER, DAVID AUGUSTUS (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:AUGUSTUS
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7593 W BOYNTON BEACH BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-6162
Mailing Address - Country:US
Mailing Address - Phone:561-649-7000
Mailing Address - Fax:561-964-4603
Practice Address - Street 1:107 JOHN F KENNEDY DR STE B
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1153
Practice Address - Country:US
Practice Address - Phone:561-295-6962
Practice Address - Fax:561-249-2512
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48584208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043885500Medicaid
FL650327590OtherTAX ID #
FLE62757Medicare UPIN
FL11487AMedicare PIN
FL11487WMedicare PIN