Provider Demographics
NPI:1811190093
Name:MILES, ROSALYN BALL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSALYN
Middle Name:BALL
Last Name:MILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROSALYN
Other - Middle Name:PATRICE
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:110 LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3632
Mailing Address - Country:US
Mailing Address - Phone:314-809-6091
Mailing Address - Fax:877-772-9805
Practice Address - Street 1:110 LANCASTER DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3632
Practice Address - Country:US
Practice Address - Phone:314-809-6091
Practice Address - Fax:877-772-9805
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050146922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology