Provider Demographics
NPI:1518917079
Name:MILLER, RAYMOND J (DO)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:J
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:121 W HIGH ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4340
Mailing Address - Country:US
Mailing Address - Phone:419-998-4375
Mailing Address - Fax:419-998-4586
Practice Address - Street 1:525 N EASTOWN RD
Practice Address - Street 2:SUITE D
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45807-2268
Practice Address - Country:US
Practice Address - Phone:419-224-4646
Practice Address - Fax:419-224-2410
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2013-01-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34.003926207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0611074Medicaid
OHMI0623585Medicare PIN
OHE96256Medicare UPIN