=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497063614
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRED MILEY, M. D., P. A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2010
-----------------------------------------------------
Last Update Date | 09/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 SE 17TH ST SUITE 203
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34471-4196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-629-4448
-----------------------------------------------------
Fax | 352-867-7015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2078
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34478-2078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-629-4448
-----------------------------------------------------
Fax | 352-867-7015
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. FREDERICK G. MILEY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 352-629-4448
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | ME13722
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------