Provider Demographics
NPI:1902045156
Name:RYAN T. MILLER,M.D.,LLC
Entity Type:Organization
Organization Name:RYAN T. MILLER,M.D.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-931-5080
Mailing Address - Street 1:1390 HIGHWAY 61
Mailing Address - Street 2:MEDICAL OFFICE CENTER NORTH STE 3200
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4137
Mailing Address - Country:US
Mailing Address - Phone:636-931-5080
Mailing Address - Fax:636-933-5090
Practice Address - Street 1:1390 HIGHWAY 61
Practice Address - Street 2:MEDICAL OFFICE CENTER NORTH STE 3200
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4137
Practice Address - Country:US
Practice Address - Phone:636-931-5080
Practice Address - Fax:636-933-5090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty