Provider Demographics
NPI:1790799229
Name:MILLER, ROBERT R (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 KY RT 321
Mailing Address - Street 2:STE 1
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653
Mailing Address - Country:US
Mailing Address - Phone:606-889-0095
Mailing Address - Fax:606-889-0080
Practice Address - Street 1:5230 KY RT 321
Practice Address - Street 2:STE 1
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653
Practice Address - Country:US
Practice Address - Phone:606-889-0095
Practice Address - Fax:606-889-0080
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00235213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80002355Medicaid
U68902Medicare UPIN
KY80002355Medicaid