Provider Demographics
NPI:1841433802
Name:MILLER, SCOTT RICHARD (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:RICHARD
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8725 N WICKHAM RD STE 301
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-434-9200
Practice Address - Fax:321-434-9202
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119882207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHX583XOtherFL HF MEDICARE
FL012202500Medicaid
FL14V20OtherBCBS
FL5401992OtherAETNA
FLHX583YOtherFL HFPSI MEDICARE