Provider Demographics
NPI:1053415315
Name:MILLER, JEFFREY LEIGH (MD)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LEIGH
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 1:3218 W AZEELE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609
Mailing Address - Country:US
Mailing Address - Phone:813-879-1188
Mailing Address - Fax:813-872-6126
Practice Address - Street 1:3218 W AZEELE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609
Practice Address - Country:US
Practice Address - Phone:813-879-1188
Practice Address - Fax:813-872-6126
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2020-12-11
Deactivation Date:2020-12-03
Deactivation Code:
Reactivation Date:2020-12-11
Provider Licenses
StateLicense IDTaxonomies
FLME0027032207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D62113Medicare UPIN
FL29948YMedicare PIN