Healthcare Provider Details

I. General information

NPI: 1205564960
Provider Name (Legal Business Name): MILES DANIEL HAMM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 E HWY 50 STE B1
CLERMONT FL
34711-5190
US

IV. Provider business mailing address

1745 E HWY 50 STE B1
CLERMONT FL
34711-5190
US

V. Phone/Fax

Practice location:
  • Phone: 407-226-3733
  • Fax: 407-226-3734
Mailing address:
  • Phone: 352-404-8428
  • Fax: 866-984-4064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9116232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: