MEDICARE: TRAVIS DANIEL MILLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1427235803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS DANIEL MILLER

Provider Business Mailing Address
First Line	:	1078 HOSPITAL RD
Second Line	:
City	:	FORT STORY
State	:	VA
Zip	:	23459-1197
Country	:	US
Telephone Number	:	757-422-7936
Fax Number	:	757-422-7949

Provider Business Practice Location Address
First Line	:	1078 HOSPITAL RD
Second Line	:
City	:	FORT STORY
State	:	VA
Zip	:	23459-1197
Country	:	US
Telephone Number	:	757-422-7936
Fax Number	:	757-422-7949

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	01/28/2008

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Directions to “ TRAVIS DANIEL MILLER ” Practice Location

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