Healthcare Provider Details

I. General information

NPI: 1669514030
Provider Name (Legal Business Name): RICHARD CHARLES MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 N WYATT DRIVE SUITE 108
TUCSON AZ
85712-2152
US

IV. Provider business mailing address

12931 E SPEEDWAY BLVD
TUCSON AZ
85748
US

V. Phone/Fax

Practice location:
  • Phone: 520-881-8161
  • Fax: 520-881-8163
Mailing address:
  • Phone: 520-886-2838
  • Fax: 520-886-9292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number4719
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: