Provider Demographics
NPI:1336358340
Name:MILLER, ROSALYN G (DO)
Entity type:Individual
Prefix:DR
First Name:ROSALYN
Middle Name:G
Last Name:MILLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ROSALYN
Other - Middle Name:G
Other - Last Name:PEACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:16605 SOUTHWEST FWY STE 335
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3472
Mailing Address - Country:US
Mailing Address - Phone:346-874-2060
Mailing Address - Fax:
Practice Address - Street 1:16605 SOUTHWEST FWY STE 335
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:346-874-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018575207V00000X
OH58.002214207V00000X
TXS1865207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX400007701Medicaid
MI1336358340Medicaid