Provider Demographics
NPI:1093793507
Name:MILLER, RICHARD E (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
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 1:12016 87TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6014
Mailing Address - Country:US
Mailing Address - Phone:425-820-1314
Mailing Address - Fax:
Practice Address - Street 1:12016 87TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6014
Practice Address - Country:US
Practice Address - Phone:425-820-1314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000207452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA202653OtherL&I PROVIDER NUMBER
WA202733OtherL&I PROVIDER NUMBER
PA1026667960001Medicaid
WA8131757Medicaid
WA120929OtherL&I PROVIDER NUMBER
WAAB03751Medicare ID - Type UnspecifiedPROVIDER NUMBER
WA8131757Medicaid
WA120929OtherL&I PROVIDER NUMBER
WAA00698Medicare UPIN
WA8854249Medicare ID - Type UnspecifiedPROVIDER NUMBER
WA202733OtherL&I PROVIDER NUMBER