Provider Demographics
NPI:1912970542
Name:MILLER, PAMELA (DO)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 TAMIAMI TRL S STE 108
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-4133
Mailing Address - Country:US
Mailing Address - Phone:941-488-2332
Mailing Address - Fax:941-429-3430
Practice Address - Street 1:1101 TAMIAMI TRL S STE 108
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-4133
Practice Address - Country:US
Practice Address - Phone:941-488-2332
Practice Address - Fax:941-429-3430
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAC5582919207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6005200Medicaid
SD6005200Medicaid