Provider Demographics
NPI:1750400792
Name:MILLER, ALAN EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:EDWARD
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:705 WELLS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2982
Mailing Address - Country:US
Mailing Address - Phone:904-282-6331
Mailing Address - Fax:904-619-1080
Practice Address - Street 1:1865 LIME ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4744
Practice Address - Country:US
Practice Address - Phone:904-321-2422
Practice Address - Fax:904-321-2434
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1027512081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002623200Medicaid
FLP00847538OtherMEDICARE RAILROAD
FL145A8OtherFLORIDA BLUE
FLP00847538OtherMEDICARE RAILROAD