Provider Demographics
NPI:1013983675
Name:MILLER, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
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 7137
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39506-7137
Mailing Address - Country:US
Mailing Address - Phone:228-248-2480
Mailing Address - Fax:228-248-2484
Practice Address - Street 1:2781 C T SWITZER SR DR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4536
Practice Address - Country:US
Practice Address - Phone:228-248-2480
Practice Address - Fax:228-248-2484
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS012863208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00608339OtherRAILROAD MEDICARE
MS00125370Medicaid
MS240000072Medicare PIN
MS00125370Medicaid
MS240007317Medicare PIN