Healthcare Provider Details

I. General information

NPI: 1942324991
Provider Name (Legal Business Name): RONALD W MILLER MA, CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7658 W BOCA RATON RD
PEORIA AZ
85381-4688
US

IV. Provider business mailing address

7658 W BOCA RATON RD
PEORIA AZ
85381-4688
US

V. Phone/Fax

Practice location:
  • Phone: 623-412-0997
  • Fax:
Mailing address:
  • Phone: 623-412-0997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License NumberDA1363
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: