MEDICARE: DR. THOMAS P MILES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	G21729	CA

General Provider Information

NPI Number	:	1255325908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS P MILES M.D.

Provider Business Mailing Address
First Line	:	1310 PRENTICE DR
Second Line	:	STE G
City	:	HEALDSBURG
State	:	CA
Zip	:	95448-3384
Country	:	US
Telephone Number	:	707-473-2840
Fax Number	:	707-433-6184

Provider Business Practice Location Address
First Line	:	1310 PRENTICE DR
Second Line	:	STE G
City	:	HEALDSBURG
State	:	CA
Zip	:	95448-3384
Country	:	US
Telephone Number	:	707-473-2840
Fax Number	:	707-433-6184

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	08/24/2010

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