Provider Demographics
NPI:1992751176
Name:MILLER, DALE EDWARD (MD)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:EDWARD
Last Name:MILLER
Suffix:
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:PO BOX 100806
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0806
Mailing Address - Country:US
Mailing Address - Phone:800-901-2102
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:700 WEST OAK STREET
Practice Address - Street 2:
Practice Address - City:KISSIMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4924
Practice Address - Country:US
Practice Address - Phone:407-846-2266
Practice Address - Fax:407-518-3616
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56776207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064871000Medicaid
FL11266OtherBLUE CROSS BLUE SHIELD FL
FL050090382OtherRAILROAD MEDICARE
FL11266YMedicare PIN
FL11266OtherBLUE CROSS BLUE SHIELD FL