Provider Demographics
NPI:1457349276
Name:MILLER, STEPHEN KERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:KERRY
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2007 HARRISON AVE
Mailing Address - Street 2:STE A
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4545
Mailing Address - Country:US
Mailing Address - Phone:850-872-0835
Mailing Address - Fax:
Practice Address - Street 1:2007 HARRISON AVE
Practice Address - Street 2:STE A
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4545
Practice Address - Country:US
Practice Address - Phone:850-872-0835
Practice Address - Fax:850-784-9154
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057317207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063521900Medicaid
10391Medicare ID - Type Unspecified
FLE49336Medicare UPIN
FL110034788Medicare PIN