Healthcare Provider Details

I. General information

NPI: 1396814125
Provider Name (Legal Business Name): STEPHEN R MILLER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 SW 34TH CIRCLE SUITE 102
OCALA FL
34474
US

IV. Provider business mailing address

3301 SW 34TH CIRCLE SUITE 102
OCALA FL
34474
US

V. Phone/Fax

Practice location:
  • Phone: 352-861-0444
  • Fax: 352-861-0464
Mailing address:
  • Phone: 352-861-0444
  • Fax: 352-861-0464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberP00001605
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: