Provider Demographics
NPI:1104881002
Name:MILLER, JACOB W (DO)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:W
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:155 KINGSLEY LN
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4629
Mailing Address - Country:US
Mailing Address - Phone:757-278-2240
Mailing Address - Fax:757-489-6469
Practice Address - Street 1:155 KINGSLEY LN
Practice Address - Street 2:SUITE 400
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4629
Practice Address - Country:US
Practice Address - Phone:757-278-2240
Practice Address - Fax:757-489-6469
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2019-04-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0102036908207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB05019Medicare UPIN
VA013533B09Medicare PIN
VAP00457426Medicare PIN