=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194773895
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID A MILLER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2006
-----------------------------------------------------
Last Update Date | 06/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12977 SOUTHERN BLVD SUITE202
-----------------------------------------------------
City | LOXAHATCHEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33470-9255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-204-3620
-----------------------------------------------------
Fax | 561-204-3621
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12977 SOUTHERN BLVD SUITE 202
-----------------------------------------------------
City | LOXAHATCHEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33470-9255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-204-3620
-----------------------------------------------------
Fax | 561-204-3621
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. DAVID A MILLER JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 561-204-3620
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME48584
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------