Provider Demographics
NPI:1063481539
Name:MILLER, RICHARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 FONTAINE BLVD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-1061
Mailing Address - Country:US
Mailing Address - Phone:719-390-7885
Mailing Address - Fax:719-390-8694
Practice Address - Street 1:5115 FONTAINE BLVD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1061
Practice Address - Country:US
Practice Address - Phone:719-390-7885
Practice Address - Fax:719-390-8694
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31078207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01310788Medicaid
CO01310788Medicaid
G54256Medicare UPIN