Provider Demographics
NPI:1477841252
Name:MILLER, JENNIFER R (DPM)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10430 PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-1228
Mailing Address - Country:US
Mailing Address - Phone:314-426-8811
Mailing Address - Fax:314-423-8824
Practice Address - Street 1:10430 PAGE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-1228
Practice Address - Country:US
Practice Address - Phone:314-426-8811
Practice Address - Fax:314-423-8824
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002359213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery