Provider Demographics
NPI:1265456255
Name:MILLER, RICHARD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 36TH STREET
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6574
Mailing Address - Country:US
Mailing Address - Phone:863-983-2282
Mailing Address - Fax:863-983-2864
Practice Address - Street 1:1265 36TH STREET
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6574
Practice Address - Country:US
Practice Address - Phone:863-983-2282
Practice Address - Fax:863-983-2864
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3358363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA3358OtherSTATE LICENSE