=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518072826
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRAIG A. MILLER, DO, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2006
-----------------------------------------------------
Last Update Date | 10/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 HAND AVE SUITE K
-----------------------------------------------------
City | ORMOND BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32174-8194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-852-3652
-----------------------------------------------------
Fax | 386-673-8009
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 HAND AVE SUITE K
-----------------------------------------------------
City | ORMOND BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32174-8194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-852-3652
-----------------------------------------------------
Fax | 386-673-8009
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DR. CRAIG ALLAN MILLER
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 386-852-3652
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS7698
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------