Provider Demographics
NPI:1275511727
Name:MILAM, DEBORAH (PA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:MILAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4896A HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-7840
Mailing Address - Country:US
Mailing Address - Phone:850-526-6700
Mailing Address - Fax:850-526-5021
Practice Address - Street 1:4896A HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-7840
Practice Address - Country:US
Practice Address - Phone:850-526-6700
Practice Address - Fax:850-526-5021
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003018363A00000X
FLPA9108426363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003018OtherOTHER
FLFKUJ6OtherFLORIDA BLUE
GA003018OtherOTHER