Provider Demographics
NPI:1780608414
Name:MIERS, LOUIS EDWARD (PA)
Entity type:Individual
Prefix:
First Name:LOUIS EDWARD
Middle Name:
Last Name:MIERS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 KING ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4735
Mailing Address - Country:US
Mailing Address - Phone:904-384-3343
Mailing Address - Fax:904-389-6748
Practice Address - Street 1:1824 KING ST
Practice Address - Street 2:SUITE 200
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4735
Practice Address - Country:US
Practice Address - Phone:904-384-3343
Practice Address - Fax:904-389-6748
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1765363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292276200Medicaid
FLP00461165OtherMEDICARE RAILROAD
FLS85278Medicare UPIN
FLP00461165OtherMEDICARE RAILROAD