Provider Demographics
NPI:1952341497
Name:MILLER, RANDALL (MD)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:
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 1:351 MOOSA BLVD
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-3625
Mailing Address - Country:US
Mailing Address - Phone:337-550-6963
Mailing Address - Fax:337-550-8683
Practice Address - Street 1:351 MOOSA BLVD
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-3625
Practice Address - Country:US
Practice Address - Phone:337-550-6963
Practice Address - Fax:337-550-8683
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1485080Medicaid
LA$$$$$$$$$OtherTRICARE
LA1485080Medicaid
LA$$$$$$$$$OtherTRICARE
LA5E218CV04Medicare PIN
LAG85166Medicare UPIN