Healthcare Provider Details

I. General information

NPI: 1912092248
Provider Name (Legal Business Name): ANGELA MYLES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 BAPTIST HEALTH DR #100
LITTLE ROCK AR
72205-6326
US

IV. Provider business mailing address

9600 BAPTIST HEALTH DR #100
LITTLE ROCK AR
72205-6326
US

V. Phone/Fax

Practice location:
  • Phone: 501-221-1781
  • Fax: 501-225-3323
Mailing address:
  • Phone: 501-221-1781
  • Fax: 501-225-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberE7754
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: