Provider Demographics
NPI:1023016573
Name:MILLER, PATRICK R (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:R
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 6423
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5810 W BEVERLY LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1800
Practice Address - Country:US
Practice Address - Phone:623-312-3000
Practice Address - Fax:623-312-3060
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ213022085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ353376Medicaid
AZ353376Medicaid
AZG24657Medicare UPIN
AZZ127168Medicare PIN
AZ766065OtherWELLCARE MEDICARE ADVANTAGE
AZ353376Medicaid
AZ21302OtherLICENSE
AZP00699857OtherRR MEDICARE