Individual
RONALD D TILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
640 E 700 S, SUITE 203, ST GEORGE, UT 84770-4023
(435) 574-9777
Mailing address
5201 HUNTERS GLENN CT, EL PASO, TX 79932-3110
(915) 525-2860
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA02801
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
216611801
—
TX
05
—
72328878
—
NM
01
—
8N9977
TEXAS BLUE SHIELD NUMBER
TX
Enumeration date
06/21/2006
Last updated
04/30/2012
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