Provider Demographics
NPI:1184678336
Name:MILLER, RANDALL S (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:S
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 1:2838 BELLINI DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3119
Mailing Address - Country:US
Mailing Address - Phone:702-813-4974
Mailing Address - Fax:
Practice Address - Street 1:2370 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5077
Practice Address - Country:US
Practice Address - Phone:702-897-3800
Practice Address - Fax:702-897-3801
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9270207P00000X, 208000000X
NV9720207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F77218Medicare UPIN