Provider Demographics
NPI:1215124425
Name:MILLER, WESTON P III (MD)
Entity type:Individual
Prefix:
First Name:WESTON
Middle Name:P
Last Name:MILLER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-4043
Mailing Address - Country:US
Mailing Address - Phone:337-898-1520
Mailing Address - Fax:337-898-1527
Practice Address - Street 1:2620 NORTH DR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4043
Practice Address - Country:US
Practice Address - Phone:337-898-1520
Practice Address - Fax:337-898-1527
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012747174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1183270Medicaid
LA1183270Medicaid
LA53116Medicare PIN