Provider Demographics
NPI:1568449775
Name:MILLER, ROGER (PHD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 FORESIGHT CIRCLE
Mailing Address - Street 2:#2
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505
Mailing Address - Country:US
Mailing Address - Phone:970-254-8600
Mailing Address - Fax:970-254-8603
Practice Address - Street 1:2516 FORESIGHT CIR
Practice Address - Street 2:#2
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505
Practice Address - Country:US
Practice Address - Phone:970-254-8600
Practice Address - Fax:970-254-8603
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO023869OtherMEDICAID OPTIONS
CO023869OtherMEDICAID OPTIONS