Healthcare Provider Details

I. General information

NPI: 1568449775
Provider Name (Legal Business Name): ROGER MILLER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 BROWNWOOD BLVD STE 100
THE VILLAGES FL
32163-2040
US

IV. Provider business mailing address

2955 BROWNWOOD BLVD STE 100
THE VILLAGES FL
32163-2040
US

V. Phone/Fax

Practice location:
  • Phone: 352-492-0156
  • Fax:
Mailing address:
  • Phone: 352-492-0156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberPY10715
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: