Healthcare Provider Details

I. General information

NPI: 1114024544
Provider Name (Legal Business Name): JOHN B MILTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 N. 3RD STREET
MACCLENNY FL
32063
US

IV. Provider business mailing address

4702 VAN KLEECK DR
NEW SMYRNA BEACH FL
32169-4208
US

V. Phone/Fax

Practice location:
  • Phone: 904-259-3151
  • Fax:
Mailing address:
  • Phone: 386-428-0054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME53961
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: