Provider Demographics
NPI:1205564960
Name:HAMM, MILES DANIEL (PA-C)
Entity type:Individual
Prefix:
First Name:MILES
Middle Name:DANIEL
Last Name:HAMM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7350 FUTURES DR STE 16
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9084
Mailing Address - Country:US
Mailing Address - Phone:407-226-3733
Mailing Address - Fax:407-226-3734
Practice Address - Street 1:7350 FUTURES DR STE 16
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9084
Practice Address - Country:US
Practice Address - Phone:407-226-3733
Practice Address - Fax:407-226-3734
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116232363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant