Provider Demographics
NPI:1750049623
Name:MILLER, JOHN CAMERON
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CAMERON
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 OCEAN WAY APT 30D
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-7259
Mailing Address - Country:US
Mailing Address - Phone:561-312-9981
Mailing Address - Fax:
Practice Address - Street 1:1420 OCEAN WAY APT 30D
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-7259
Practice Address - Country:US
Practice Address - Phone:561-312-9981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94025932390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program