Provider Demographics
NPI:1770503336
Name:MILLER, GARY E (M D)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:E
Last Name:MILLER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
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:77090-2607
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:77090-2607
Practice Address - Country:US
Practice Address - Phone:281-440-6899
Practice Address - Fax:281-587-1164
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC83782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4498903OtherAETNA
TX10006240OtherAMERIGROUP
TX53626OtherCIGNA
TX098224101Medicaid
TXOOFO1UOtherBLUE CROSS/BLUE SHIELD
TX10006240OtherAMERIGROUP
TXOOFO1UMedicare ID - Type Unspecified