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Individual

JAMESON JUAN MILES

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
B.S.

Contact information

Practice address
2789 ORTIZ AVE, FORT MYERS, FL 33905-7806
(239) 791-1586
(239) 278-9058
Mailing address
2789 ORTIZ AVE, FORT MYERS, FL 33905-7806
(239) 791-1586
(239) 278-9058

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
M420430771460
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
M420430771460
DRIVER'S LICENSE
FL
Enumeration date
09/19/2012
Last updated
09/19/2012
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