MEDICARE: HERMAN MILLER JR. M.D

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	207VG0400X	Gynecology Physician	ME034692	FL
2	207VG0400X	Gynecology Physician	21026	GA

General Provider Information

NPI Number	:	1972695971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HERMAN MILLER JR. M.D

Provider Business Mailing Address
First Line	:	4131 UNIVERSITY BLVD S
Second Line	:	BUILDING #2
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4326
Country	:	US
Telephone Number	:	904-730-5173
Fax Number	:

Provider Business Practice Location Address
First Line	:	4131 UNIVERSITY BLVD S
Second Line	:	BUILDING #2
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4326
Country	:	US
Telephone Number	:	904-730-5173
Fax Number	:

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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Directions to “ HERMAN MILLER JR. M.D” Practice Location

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