Healthcare Provider Details

I. General information

NPI: 1134127384
Provider Name (Legal Business Name): PETER ANDREW MILLER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/21/2006

III. Provider practice location address

76 COURT ST
MIDDLEBURY VT
05753-1419
US

IV. Provider business mailing address

76 COURT ST P.O. BOX 586
MIDDLEBURY VT
05753-1419
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-1200
  • Fax: 802-388-3566
Mailing address:
  • Phone: 802-388-1200
  • Fax: 802-388-3566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number056-0000150
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: