Provider Demographics
NPI:1902807092
Name:MILLER, RONALD JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAMES
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:380 N 200 W
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-7079
Mailing Address - Country:US
Mailing Address - Phone:801-298-1300
Mailing Address - Fax:801-296-6199
Practice Address - Street 1:380 N 200 W
Practice Address - Street 2:SUITE 209
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7079
Practice Address - Country:US
Practice Address - Phone:801-298-1300
Practice Address - Fax:801-296-6199
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT184451-12052085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ923616Medicaid
UT10435Medicaid
WY120411400Medicaid
NV002089159Medicaid
UTP00651545OtherRR MEDICARE
UTP00199609OtherRR MEDICARE
E29180Medicare UPIN
UT10435Medicaid
UTP00651545OtherRR MEDICARE