Miller, Jackie Robinson

Miller, Jackie Robinson is an individual health care provider with primary practice located at 701 W Plymouth Ave , Deland FL 32720-3236. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Miller, Jackie Robinson can be contacted via phone (386) 943-4522.

Contact Information

Primary practice address
701 W Plymouth Ave Deland FL 32720-3236
Phone: (386) 943-4522
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X OS5051 Florida

Profile Details

NPI number 1205899507
LBN Legal business name Miller, Jackie Robinson
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 8th, 2006
Last updated Aug 3rd, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205899507 NPPES
Florida Other 57226 BCBS
Florida MEDICAID 250243700 BCBS

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