Provider Demographics
NPI:1659434488
Name:MILLER, RICK E (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:E
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:RICKY
Other - Middle Name:EARL
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2661 PURSLANE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-2436
Mailing Address - Country:US
Mailing Address - Phone:262-716-6401
Mailing Address - Fax:
Practice Address - Street 1:515 27TH ST E
Practice Address - Street 2:STE 3
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1864
Practice Address - Country:US
Practice Address - Phone:941-748-2697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2018-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1047103TC0700X
FLPY 9037103TC0700X
FL9037103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3904330Medicaid
WI3290Medicare PIN