Provider Demographics
NPI:1699059055
Name:MILLER, COUNCIL JR (MD)
Entity type:Individual
Prefix:DR
First Name:COUNCIL
Middle Name:
Last Name:MILLER
Suffix:JR
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:P.OBOX HM2415
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:BERMUDA
Mailing Address - Zip Code:HMJX
Mailing Address - Country:BM
Mailing Address - Phone:441-295-4329
Mailing Address - Fax:441-292-7743
Practice Address - Street 1:75 VICTORIA STREET
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:BERMUDA
Practice Address - Zip Code:HM12
Practice Address - Country:BM
Practice Address - Phone:441-295-4329
Practice Address - Fax:441-292-7743
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC34957208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery