Provider Demographics
NPI:1003968058
Name:MILLER, RANDY KING (DO)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:KING
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3800 S NATIONAL AVE
Mailing Address - Street 2:STE 540
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5209
Mailing Address - Country:US
Mailing Address - Phone:417-269-5712
Mailing Address - Fax:417-269-4869
Practice Address - Street 1:25376 STATE HIGHWAY 39
Practice Address - Street 2:STE 301
Practice Address - City:SHELL KNOB
Practice Address - State:MO
Practice Address - Zip Code:65747-7343
Practice Address - Country:US
Practice Address - Phone:417-236-2680
Practice Address - Fax:417-236-2683
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2010-12-28
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Provider Licenses
StateLicense IDTaxonomies
MOMO115530207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO249997503Medicaid
MO136660001Medicare Oscar/Certification
MO249997503Medicaid
MOG29561Medicare UPIN