Provider Demographics
NPI:1588604797
Name:MILLER, RONALD C (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:C
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 1:26260 N 74TH DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-7363
Mailing Address - Country:US
Mailing Address - Phone:419-601-1945
Mailing Address - Fax:
Practice Address - Street 1:26260 N 74TH DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-7363
Practice Address - Country:US
Practice Address - Phone:419-601-1945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43230207R00000X
OH35072072207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ625202Medicaid
OH0859403Medicare ID - Type Unspecified
OH2074071Medicaid