Provider Demographics
NPI:1174571558
Name:MILLER, RONALD A (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1111 BAKER AVE
Mailing Address - Street 2:GLACIER MEDICAL ASSOCIATES
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2901
Mailing Address - Country:US
Mailing Address - Phone:406-862-2515
Mailing Address - Fax:406-862-4229
Practice Address - Street 1:1111 BAKER AVE
Practice Address - Street 2:GLACIER MEDICAL ASSOCIATES
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2901
Practice Address - Country:US
Practice Address - Phone:406-862-2515
Practice Address - Fax:406-862-4229
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3618207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT27D0411341OtherCLIA ID#--LAB CERT
MTCI2709OtherRAILRAOD MEDICARE GRP#
MT000007830OtherBLUE CROSS/SHIELD PIN
MT080026843OtherRAILRAID MEDICARE PIN#
MT3618OtherMONTANA STATE LICENSE
MT0015301Medicaid
MT810350909OtherFEIN
MT1104882232OtherGLACIER MEDICAL ASSOC NPI
MT000008287OtherMEDICARE PART B GRP ID#
MT3618OtherMONTANA STATE LICENSE
MT0015301Medicaid
MT1104882232OtherGLACIER MEDICAL ASSOC NPI
D90335Medicare UPIN