Healthcare Provider Details

I. General information

NPI: 1164464236
Provider Name (Legal Business Name): MILLIE P POOLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 SW 1ST AVE
OCALA FL
34471-0900
US

IV. Provider business mailing address

1025 SW 1ST AVE
OCALA FL
34471-0900
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-6599
  • Fax: 352-732-1198
Mailing address:
  • Phone: 352-732-6599
  • Fax: 352-732-4816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME76973
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME76973
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: