Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH6223 | FL |
NPI | 1235108648 |
---|---|
Provider Name | Jay Roy Miller |
First Address | Port Richey, FL 34668-6327 |
Second Address | Port Richey, FL 34668-6836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 08/07/2007 |