Provider Demographics
NPI:1558665968
Name:MILLER, RICHARD FREDERICK (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:FREDERICK
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13856 EGRET LN
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-4507
Mailing Address - Country:US
Mailing Address - Phone:727-571-4276
Mailing Address - Fax:
Practice Address - Street 1:5707 N 22ND STREET
Practice Address - Street 2:MENTAL HEALTH CARE, INC.
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610
Practice Address - Country:US
Practice Address - Phone:813-239-8096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS72392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry