Healthcare Provider Details

I. General information

NPI: 1477951556
Provider Name (Legal Business Name): JAVIER MILLER, M.D
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E MARKS ST
ORLANDO FL
32803-4156
US

IV. Provider business mailing address

1600 E MARKS ST
ORLANDO FL
32803-4156
US

V. Phone/Fax

Practice location:
  • Phone: 407-896-4159
  • Fax:
Mailing address:
  • Phone: 407-896-4159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0054205
License Number StateFL

VIII. Authorized Official

Name: DR. JAVIER MILLER
Title or Position: MD.
Credential:
Phone: 407-896-4159