Provider Demographics
NPI:1265456255
Name:MILLER, RICHARD (PA-C)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 BEACHLAND BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-1707
Mailing Address - Country:US
Mailing Address - Phone:772-268-9800
Mailing Address - Fax:772-365-4528
Practice Address - Street 1:660 BEACHLAND BLVD STE 202
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-1707
Practice Address - Country:US
Practice Address - Phone:772-268-9800
Practice Address - Fax:772-365-4528
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3358363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA3358OtherSTATE LICENSE