Provider Demographics
NPI:1689690166
Name:GARY E MILLER M D P A
Entity Type:Organization
Organization Name:GARY E MILLER M D P A
Other - Org Name:ALTERNATIVE SERVICES NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:281-440-6899
Mailing Address - Street 1:17115 RED OAK DR
Mailing Address - Street 2:SUITE 119
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2641
Mailing Address - Country:US
Mailing Address - Phone:281-440-6899
Mailing Address - Fax:281-587-1164
Practice Address - Street 1:17115 RED OAK DR
Practice Address - Street 2:SUITE 119
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2640
Practice Address - Country:US
Practice Address - Phone:281-440-6899
Practice Address - Fax:281-587-1164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2191983-01Medicaid