=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851340103
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID AUGUSTUS MILLER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2006
-----------------------------------------------------
Last Update Date | 03/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 JOHN F KENNEDY DR STE B
-----------------------------------------------------
City | ATLANTIS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33462-1153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-295-6962
-----------------------------------------------------
Fax | 561-249-2512
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7593 W BOYNTON BEACH BLVD STE 220
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33437-6162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-649-7000
-----------------------------------------------------
Fax | 561-964-4603
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME48584
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME48584
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------