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General NPI Number Information
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NPI Number | 1568512663
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Entity Type | Organization
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Legal Business Name | JUAN MILLER MD PA
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3829 ATLANTIC BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32207-2032
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Country | US
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Telephone | 904-398-9861
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Fax | 904-399-3915
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Provider Business Mailing Address
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Address Line | 3829 ATLANTIC BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32207-2032
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Country | US
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Telephone | 904-398-9861
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Fax | 904-399-3915
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Authorized Official
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Title or Position | OWNER
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Name | JUAN MILLER
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Credential | MD
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Telephone | 904-398-9861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME53959
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License Number State | FL
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